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General NPI Number Information
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NPI Number | 1164593729
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Entity Type | Individual
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Provider Name | JOHN S MCCONAGHY LPC
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4601 MORGANFORD RD ST. LOUIS ACADEMY
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1409
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Country | US
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Telephone | 314-481-5100
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Fax | 314-259-1147
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Provider Business Mailing Address
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Address Line | 7167 WASHINGTON AVENUE
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City | ST. LOUIS
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State | MO
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Zip | 63130
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Country | US
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Telephone | 314-727-1939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2001004874
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License Number State | MO
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