Healthcare Provider Details

I. General information

NPI: 1720251861
Provider Name (Legal Business Name): SUSAN M MCGUIRE BRETH M.ED., LPC, NCC, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5933 S HIGHWAY 94 STE 110
WELDON SPRING MO
63304-5609
US

IV. Provider business mailing address

5933 S HIGHWAY 94 STE 110
WELDON SPRING MO
63304-5609
US

V. Phone/Fax

Practice location:
  • Phone: 636-342-0202
  • Fax:
Mailing address:
  • Phone: 636-342-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001978
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: