Healthcare Provider Details

I. General information

NPI: 1982525572
Provider Name (Legal Business Name): CEDAR GROVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14323 S OUTER 40 RD
TOWN AND COUNTRY MO
63017-5739
US

IV. Provider business mailing address

14323 S OUTER 40 RD
TOWN AND COUNTRY MO
63017-5739
US

V. Phone/Fax

Practice location:
  • Phone: 314-325-6886
  • Fax:
Mailing address:
  • Phone: 314-325-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FNU MAILISI
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential:
Phone: 314-325-6886