Healthcare Provider Details

I. General information

NPI: 1295650026
Provider Name (Legal Business Name): STORM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CRESTWOOD EXECUTIVE CTR STE 435
SAINT LOUIS MO
63126-1916
US

IV. Provider business mailing address

50 CRESTWOOD EXECUTIVE CTR STE 435
SAINT LOUIS MO
63126-1916
US

V. Phone/Fax

Practice location:
  • Phone: 314-254-3455
  • Fax:
Mailing address:
  • Phone: 314-254-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JILL STORM
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MED
Phone: 314-456-9148