Healthcare Provider Details

I. General information

NPI: 1154806644
Provider Name (Legal Business Name): A BALANCED PERSPECTIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 UNION RD SUITE 225
ST. LOUIS MO
63129-1064
US

IV. Provider business mailing address

1021 ROSEBERRY DR
WATERLOO IL
62298-6069
US

V. Phone/Fax

Practice location:
  • Phone: 618-604-5032
  • Fax:
Mailing address:
  • Phone: 618-604-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. DAVID C JUELFS
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 618-604-5032