Healthcare Provider Details

I. General information

NPI: 1205749637
Provider Name (Legal Business Name): MOLLY ELIZABETH ROIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E LOCKWOOD AVE
SAINT LOUIS MO
63119-3004
US

IV. Provider business mailing address

213 E LOCKWOOD AVE
SAINT LOUIS MO
63119-3004
US

V. Phone/Fax

Practice location:
  • Phone: 314-606-0691
  • Fax:
Mailing address:
  • Phone: 314-606-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2011009533
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: