Healthcare Provider Details

I. General information

NPI: 1538874151
Provider Name (Legal Business Name): DANIELLA RAE SPENCER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 STARVIEW DR
TROY MO
63379-6907
US

IV. Provider business mailing address

125 STARVIEW DR
TROY MO
63379-6907
US

V. Phone/Fax

Practice location:
  • Phone: 314-656-6283
  • Fax:
Mailing address:
  • Phone: 314-656-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026004805
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: