Healthcare Provider Details

I. General information

NPI: 1760968093
Provider Name (Legal Business Name): R8:28
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4068 MAFFITT
ST. LOUIS MO
63113
US

IV. Provider business mailing address

1147 APPLESEED LANE APT A
OLIVETTE MO
63132
US

V. Phone/Fax

Practice location:
  • Phone: 314-368-5996
  • Fax:
Mailing address:
  • Phone: 314-368-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015006074
License Number StateMO

VIII. Authorized Official

Name: MS. MELISSA LAUREN WEBB
Title or Position: FOUNDER AND OWNER
Credential: LPC
Phone: 314-368-5996