Healthcare Provider Details

I. General information

NPI: 1043702897
Provider Name (Legal Business Name): EQUAL SHARES PARENTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 CORBEIL DR. UNIT D
ST. LOUIS MO
63146
US

IV. Provider business mailing address

10313 CORBEIL DR. UNIT D
ST. LOUIS MO
63146
US

V. Phone/Fax

Practice location:
  • Phone: 314-594-7290
  • Fax:
Mailing address:
  • Phone: 314-594-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017011985
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRECIA K. DAVIS
Title or Position: CEO/FOUNDER
Credential: LCSW
Phone: 314-305-4393