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General NPI Number Information
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NPI Number | 1619273794
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Entity Type | Individual
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Provider Name | MRS. MELISSA MARIE BRENGLE
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Gender | Female
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 4485 WESTMINSTER PL
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1812
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Country | US
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Telephone | 314-968-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 3665 ARPENT ST UNIT 1
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City | SAINT CHARLES
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State | MO
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Zip | 63301-8125
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Country | US
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Telephone | 314-623-8550
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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 |
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License Number State |
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