Healthcare Provider Details

I. General information

NPI: 1316763030
Provider Name (Legal Business Name): KATRINA LACOMBE MA, LPC, ATR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6478 SCANLAN AVE
SAINT LOUIS MO
63139-2402
US

IV. Provider business mailing address

6478 SCANLAN AVE
SAINT LOUIS MO
63139-2402
US

V. Phone/Fax

Practice location:
  • Phone: 816-877-6590
  • Fax:
Mailing address:
  • Phone: 816-877-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-215
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020032634
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: