Healthcare Provider Details

I. General information

NPI: 1023529385
Provider Name (Legal Business Name): TRANSFORMING LIVES COUNSELING SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5585 PERSHING AVE # 130
SAINT LOUIS MO
63112-4621
US

IV. Provider business mailing address

5585 PERSHING AVE STE 130
SAINT LOUIS MO
63112-1850
US

V. Phone/Fax

Practice location:
  • Phone: 314-368-6265
  • Fax: 314-261-5013
Mailing address:
  • Phone: 314-368-6265
  • Fax: 314-328-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSHANDA LYNETTE NEAL
Title or Position: OWNER
Credential: LPC
Phone: 314-368-6265