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General NPI Number Information
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NPI Number | 1720574817
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Entity Type | Organization
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Legal Business Name | CONSCIOUS CHOICES CORPORATION
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 8000 BONHOMME AVE STE 413
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City | CLAYTON
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State | MO
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Zip | 63105-3515
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Country | US
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Telephone | 314-802-8796
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Fax | 314-797-8006
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Provider Business Mailing Address
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Address Line | 8000 BONHOMME AVE STE 413
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City | CLAYTON
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State | MO
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Zip | 63105-3515
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Country | US
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Telephone | 314-802-8796
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Fax | 314-797-8006
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ROBERTA ANN MOORE
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Credential | LMFT
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Telephone | 314-802-8796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2012036889
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License Number State | MO
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