Healthcare Provider Details

I. General information

NPI: 1932586740
Provider Name (Legal Business Name): C KATKE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W PORT PLAZA DR STE 326
SAINT LOUIS MO
63146-3214
US

IV. Provider business mailing address

15455 MANCHESTER RD UNIT 161
BALLWIN MO
63022-5008
US

V. Phone/Fax

Practice location:
  • Phone: 314-548-2121
  • Fax: 636-333-4510
Mailing address:
  • Phone: 314-548-2121
  • Fax: 314-548-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW005494
License Number StateMO

VIII. Authorized Official

Name: CHRISTY KATKE
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 314-548-2121