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General NPI Number Information
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NPI Number | 1760195739
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Entity Type | Individual
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Provider Name | MICHAL DEVORAH GOLDSTEIN
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Gender | Female
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 425 S WOODS MILL RD STE 150
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-9528
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Country | US
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Telephone | 636-939-2550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 675103
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City | DETROIT
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State | MI
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Zip | 48267-5103
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2020043300
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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 | 2020043300
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License Number State | MO
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