Healthcare Provider Details

I. General information

NPI: 1760359608
Provider Name (Legal Business Name): SEDA FOLLIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HUNTER AVE STE 105
SAINT LOUIS MO
63124-2000
US

IV. Provider business mailing address

5661 TELEGRAPH RD STE 4B
SAINT LOUIS MO
63129-4275
US

V. Phone/Fax

Practice location:
  • Phone: 314-853-7474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025043854
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: