Healthcare Provider Details

I. General information

NPI: 1679685119
Provider Name (Legal Business Name): DAVID LOREN HART JR. PH. D., LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 S COMPTON AVE
SAINT LOUIS MO
63111-1554
US

IV. Provider business mailing address

2901 IOWA AVE
SAINT LOUIS MO
63118-1414
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-1770
  • Fax: 314-351-2940
Mailing address:
  • Phone: 314-664-6151
  • Fax: 314-351-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCS002663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: