Healthcare Provider Details

I. General information

NPI: 1043735012
Provider Name (Legal Business Name): COME PLAY, STL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 S GRAND BLVD STE 224
SAINT LOUIS MO
63118-1047
US

IV. Provider business mailing address

4002 BOTANICAL AVE
SAINT LOUIS MO
63110-3906
US

V. Phone/Fax

Practice location:
  • Phone: 314-312-2357
  • Fax: 844-789-2022
Mailing address:
  • Phone: 708-805-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number287066
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013041573
License Number StateMO

VIII. Authorized Official

Name: EVANGELINE BAUER
Title or Position: OWNER/FOUNDER
Credential: LCSW, CAS, RPT
Phone: 314-312-2357