Healthcare Provider Details

I. General information

NPI: 1467218974
Provider Name (Legal Business Name): A HEART FULL OF LOVE FOR MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S BRENTWOOD BLVD # 201-2
SAINT LOUIS MO
63144-1833
US

IV. Provider business mailing address

2025 S BRENTWOOD BLVD # 201-2
SAINT LOUIS MO
63144-1833
US

V. Phone/Fax

Practice location:
  • Phone: 314-643-9225
  • Fax:
Mailing address:
  • Phone: 314-643-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA L GREGORY
Title or Position: OWNER
Credential:
Phone: 314-269-6907