Healthcare Provider Details

I. General information

NPI: 1942145743
Provider Name (Legal Business Name): JUSTIN DODD LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 LEPERE AVE APT D
SAINT LOUIS MO
63132-4434
US

IV. Provider business mailing address

707 LEPERE AVE APT D
SAINT LOUIS MO
63132-4434
US

V. Phone/Fax

Practice location:
  • Phone: 515-344-1427
  • Fax:
Mailing address:
  • Phone: 515-344-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026012308
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: