Healthcare Provider Details

I. General information

NPI: 1578252805
Provider Name (Legal Business Name): LAUREN JOSTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 TESSON FERRY RD STE 50
SAINT LOUIS MO
63128-4062
US

IV. Provider business mailing address

4973A POTOMAC ST
SAINT LOUIS MO
63139-1237
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-1779
  • Fax:
Mailing address:
  • Phone: 636-734-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020028350
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: