Healthcare Provider Details

I. General information

NPI: 1063775252
Provider Name (Legal Business Name): JN RUBIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 CLAYTON RD STE 136
SAINT LOUIS MO
63124-1638
US

IV. Provider business mailing address

3 FAIR OAKS DR
SAINT LOUIS MO
63124-1514
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-1515
  • Fax: 314-995-9043
Mailing address:
  • Phone: 314-504-2232
  • Fax: 314-995-9043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2009009102
License Number StateMO

VIII. Authorized Official

Name: JANE N RUBIN
Title or Position: LICENSED PROFESSIONAL THERAPIST
Credential: LPC, NCC
Phone: 314-504-2232