Healthcare Provider Details

I. General information

NPI: 1578994562
Provider Name (Legal Business Name): ROSHANDA LYNETTE NEAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MARKET STREET STE. 110 PMB 1345
ST. LOUIS MO
63101
US

IV. Provider business mailing address

701 MARKET STREET STE. 110 PMB 1345
ST. LOUIS MO
63101
US

V. Phone/Fax

Practice location:
  • Phone: 314-368-6265
  • Fax: 314-328-0036
Mailing address:
  • Phone: 314-368-6265
  • Fax: 314-328-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.011307
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013042493
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00660100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: