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General NPI Number Information
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NPI Number | 1710158704
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Entity Type | Organization
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Legal Business Name | MAIN STREET COUNSELING, LLC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 223 N MAIN ST SUITE #3
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2828
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Country | US
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Telephone | 314-484-6198
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Fax | 636-244-1933
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Provider Business Mailing Address
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Address Line | 223 N MAIN ST SUITE #3
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2828
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Country | US
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Telephone | 314-484-6198
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Fax | 636-244-1933
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA MARIE EISENBEIS
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Credential | MSW LCSW
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Telephone | 314-484-6198
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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 | 2005040010
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License Number State | MO
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