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General NPI Number Information
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NPI Number | 1245162064
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Entity Type | Individual
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Provider Name | ELLEN MARIE KOMP
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Gender | Female
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 249 CLARKSON RD STE 102
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City | ELLISVILLE
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State | MO
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Zip | 63011-2497
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Country | US
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Telephone | 636-256-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 469 MELANIE MEADOWS LN
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City | BALLWIN
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State | MO
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Zip | 63021-6337
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Country | US
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Telephone | 636-579-2259
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2026023975
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License Number State | MO
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