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General NPI Number Information
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NPI Number | 1821744947
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Entity Type | Individual
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Provider Name | RODNEY CLOSSUM MA
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Gender | Male
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 1360 SOUTH FIFTH STREET SUITE 286
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City | ST CHARLES
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State | MO
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Zip | 63301
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Country | US
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Telephone | 314-971-4714
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Fax |
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Provider Business Mailing Address
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Address Line | 629 CLEMENS COURT
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City | KIRKWOOD
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State | MO
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Zip | 63122
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Country | US
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Telephone | 314-971-4714
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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 | 2005028055
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License Number State | MO
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