Healthcare Provider Details

I. General information

NPI: 1184730137
Provider Name (Legal Business Name): KAREN D. WASOBA M.ED., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 S OLD HIGHWAY 94 STE 104
SAINT CHARLES MO
63303-5627
US

IV. Provider business mailing address

2536 S OLD HIGHWAY 94 STE 104
SAINT CHARLES MO
63303-5627
US

V. Phone/Fax

Practice location:
  • Phone: 314-299-5116
  • Fax: 636-447-3000
Mailing address:
  • Phone: 314-299-5116
  • Fax: 636-447-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2001011582
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001011582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: