Healthcare Provider Details

I. General information

NPI: 1528657103
Provider Name (Legal Business Name): BRIAN BACHMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 BIG BEND BLVD STE 200
WEBSTER GROVES MO
63119-2715
US

IV. Provider business mailing address

1055 CAROLE LN
ELLISVILLE MO
63021-4727
US

V. Phone/Fax

Practice location:
  • Phone: 314-775-3062
  • Fax:
Mailing address:
  • Phone: 314-775-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2018043310
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018043310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: