Healthcare Provider Details

I. General information

NPI: 1568461291
Provider Name (Legal Business Name): LINDA MEDLOCK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA GILL LPC

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 EXECUTIVE PARKWAY DR STE 8
SAINT LOUIS MO
63141-6323
US

IV. Provider business mailing address

1023 EXECUTIVE PARKWAY DR STE 8
SAINT LOUIS MO
63141-6323
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-8855
  • Fax: 314-434-2331
Mailing address:
  • Phone: 314-878-7755
  • Fax: 314-434-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001986
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001986
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: