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General NPI Number Information
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NPI Number | 1245741727
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Entity Type | Organization
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Legal Business Name | MOMENTUM COACHING GROUP LLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 7710 CARONDELET AVE STE 204
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3319
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Country | US
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Telephone | 314-439-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 7710 CARONDELET AVE STE 204
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3319
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Country | US
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Telephone | 314-439-1005
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MR. DAVID WEINBERG
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Credential | LCSW
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Telephone | 314-439-1005
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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 | 2011036949
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2013007093
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2014023114
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License Number State | MO
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