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General NPI Number Information
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NPI Number | 1558257675
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Entity Type | Individual
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Provider Name | SHELLY WIMS LPC, ED.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 11701 W FLORISSANT AVE
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City | FLORISSANT
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State | MO
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Zip | 63033-6744
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Country | US
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Telephone | 314-830-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 LYNCH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1818
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Country | US
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Telephone | 314-535-5600
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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 | 2016040796
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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 | 2025044325
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License Number State | MO
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