Healthcare Provider Details

I. General information

NPI: 1518537711
Provider Name (Legal Business Name): TYE' GC STRONG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 DELMAR BLVD STE B300
SAINT LOUIS MO
63112-3078
US

IV. Provider business mailing address

5501 DELMAR BLVD STE B300
SAINT LOUIS MO
63112-3078
US

V. Phone/Fax

Practice location:
  • Phone: 314-469-4908
  • Fax:
Mailing address:
  • Phone: 314-469-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027561
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2022027144
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.109933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: