Healthcare Provider Details

I. General information

NPI: 1932818838
Provider Name (Legal Business Name): GRACE M SMITH PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

IV. Provider business mailing address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

V. Phone/Fax

Practice location:
  • Phone: 314-533-8200
  • Fax: 314-842-2552
Mailing address:
  • Phone: 314-533-8200
  • Fax: 314-842-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022034540
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: