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General NPI Number Information
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NPI Number | 1093172421
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Entity Type | Organization
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Legal Business Name | RACHEL GLASS THERAPY
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 9378 OLIVE BLVD SUITE 318
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City | SAINT LOUIS
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State | MO
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Zip | 63132-3215
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Country | US
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Telephone | 314-330-0572
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Fax |
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Provider Business Mailing Address
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Address Line | 720 BERICK DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-4904
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Country | US
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Telephone | 314-330-0572
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL GLASS
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Credential | LPC
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Telephone | 314-330-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2012019340
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License Number State | MO
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