=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881353654
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL MEHTA LPC, MS, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2021
-----------------------------------------------------
Last Update Date | 12/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2705 SAINT PETERS HOWELL RD STE D
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-346-6788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 CHALMERS ST
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-346-6788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2021047033
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------