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General NPI Number Information
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NPI Number | 1689176802
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Entity Type | Individual
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Provider Name | BARBARA BLACK LPC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2018
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Last Update Date | 03/03/2018
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Provider Practice Location Address
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Address Line | 774 GLENWAY DR
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3243
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Country | US
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Telephone | 314-690-3212
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Fax |
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Provider Business Mailing Address
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Address Line | 774 GLENWAY DR
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3243
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Country | US
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Telephone |
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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 | 2012026716
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License Number State | MO
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