Healthcare Provider Details

I. General information

NPI: 1124565833
Provider Name (Legal Business Name): GERALD BENTLEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 CLIFTON AVE
SAINT LOUIS MO
63109-3407
US

IV. Provider business mailing address

7454 GRANT VILLAGE DR APT. A
SAINT LOUIS MO
63123-1434
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-1043
  • Fax:
Mailing address:
  • Phone: 314-458-5798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0441047
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013002018
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: