Healthcare Provider Details

I. General information

NPI: 1396565966
Provider Name (Legal Business Name): RASHELLE HOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 COLONNADE CTR
SAINT LOUIS MO
63131-4328
US

IV. Provider business mailing address

417 ALSOBROOK ST
KIRKWOOD MO
63122-7310
US

V. Phone/Fax

Practice location:
  • Phone: 314-685-4388
  • Fax:
Mailing address:
  • Phone: 314-685-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: