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General NPI Number Information
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NPI Number | 1881935690
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Entity Type | Organization
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Legal Business Name | SOUND MIND CAFE
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 662 N NEW BALLAS RD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6737
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Country | US
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Telephone | 314-503-6966
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Fax |
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Provider Business Mailing Address
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Address Line | 662 N NEW BALLAS RD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6737
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Country | US
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Telephone | 314-503-6966
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SUSAN BERG
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Credential | LPC
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Telephone | 314-503-6966
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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 |
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License Number State |
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