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General NPI Number Information
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NPI Number | 1891300570
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Entity Type | Organization
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Legal Business Name | MARBLE WELLNESS
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 11042 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1244
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Country | US
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Telephone | 636-236-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 6314 S ROSEBURY AVE APT 1E
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City | SAINT LOUIS
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State | MO
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Zip | 63105-2255
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Country | US
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Telephone | 636-236-2420
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Fax |
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Authorized Official
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Title or Position | OWNER & THERAPIST
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Name | STEPHANIE KORPAL
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Credential | M.ED., LPC
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Telephone | 636-236-2420
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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 |
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License Number State |
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