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General NPI Number Information
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NPI Number | 1457219404
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Entity Type | Organization
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Legal Business Name | TETTLEBAUM THERAPY LLC
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 230 S BEMISTON AVE STE 1213
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City | SAINT LOUIS
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State | MO
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Zip | 63105-1907
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Country | US
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Telephone | 501-444-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 GAYOLA PL
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City | SAINT LOUIS
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State | MO
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Zip | 63143-2006
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Country | US
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Telephone | 501-772-7164
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | MARIANNE TETTLEBAUM
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Credential | LCSW
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Telephone | 501-772-7164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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