Healthcare Provider Details

I. General information

NPI: 1437682887
Provider Name (Legal Business Name): MARY R PASTOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKINGS DR
SAINT LOUIS MO
63130-4862
US

IV. Provider business mailing address

PO BOX 7412043
CHICAGO IL
60674-2043
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6666
  • Fax: 314-696-1214
Mailing address:
  • Phone: 314-935-6666
  • Fax: 314-696-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014038414
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: