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General NPI Number Information
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NPI Number | 1811215528
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Entity Type | Organization
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Legal Business Name | LICENSED PROFESSIONAL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 225 S MAIN ST STE. 103
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City | O FALLON
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State | MO
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Zip | 63366-2866
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Country | US
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Telephone | 636-294-5490
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Fax | 636-294-5492
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Provider Business Mailing Address
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Address Line | 225 S MAIN ST STE. 103
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City | O FALLON
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State | MO
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Zip | 63366-2866
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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 | LPC
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Name | SHANNON ROBERSON
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Credential |
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Telephone | 636-294-5490
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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 | 2010012405
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License Number State | MO
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