Healthcare Provider Details

I. General information

NPI: 1629553110
Provider Name (Legal Business Name): REBECCA KATHLEEN PIKE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

WEST COUNTY PSYCHOLOGICAL ASSOCIATES 12125 WOODCREST EXECUTIVE DRIVE #110
ST. LOUIS MO
63141
US

IV. Provider business mailing address

1131 OAKLEY LN
LAKE SAINT LOUIS MO
63367-1957
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-8599
  • Fax:
Mailing address:
  • Phone: 314-406-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004036294
License Number StateMO

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: