Healthcare Provider Details

I. General information

NPI: 1275369688
Provider Name (Legal Business Name): THALASSA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9666 OLIVE BLVD STE 370
SAINT LOUIS MO
63132-3025
US

IV. Provider business mailing address

9666 OLIVE BLVD STE 370
SAINT LOUIS MO
63132-3025
US

V. Phone/Fax

Practice location:
  • Phone: 314-499-1060
  • Fax:
Mailing address:
  • Phone: 314-499-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDSAY NICHOLS
Title or Position: OWNER
Credential: LPC
Phone: 314-499-1060