Healthcare Provider Details

I. General information

NPI: 1538098488
Provider Name (Legal Business Name): NOURISHED ROOTS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 DEVONSHIRE AVE
SAINT LOUIS MO
63109-2841
US

IV. Provider business mailing address

5330 CHIPPEWA ST
SAINT LOUIS MO
63109-2349
US

V. Phone/Fax

Practice location:
  • Phone: 314-932-7424
  • Fax:
Mailing address:
  • Phone: 314-680-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CORTNEY VARRONE
Title or Position: OWNER
Credential:
Phone: 314-680-6543