Healthcare Provider Details

I. General information

NPI: 1245710250
Provider Name (Legal Business Name): THE WHOLE YOU WELLNESS AND COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2018
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11628 OLD BALLAS RD # 223
SAINT LOUIS MO
63141-7030
US

IV. Provider business mailing address

11628 OLD BALLAS RD # 223
SAINT LOUIS MO
63141-7030
US

V. Phone/Fax

Practice location:
  • Phone: 314-827-7627
  • Fax:
Mailing address:
  • Phone: 314-827-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017041636
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2017041636
License Number StateMO

VIII. Authorized Official

Name: MEKEYA JAMA
Title or Position: OWNER
Credential: LCSW
Phone: 314-626-3308