Healthcare Provider Details

I. General information

NPI: 1144087792
Provider Name (Legal Business Name): MATTHEW MORGAN HENDERSON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 DUNCAN AVE STE 201
SAINT LOUIS MO
63110-1103
US

IV. Provider business mailing address

4912 PERSHING PL
SAINT LOUIS MO
63108-1202
US

V. Phone/Fax

Practice location:
  • Phone: 314-978-8953
  • Fax:
Mailing address:
  • Phone: 314-978-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HENDERSON
Title or Position: OWNER
Credential: LCSW
Phone: 314-978-8953