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General NPI Number Information
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NPI Number | 1922425107
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Entity Type | Individual
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Provider Name | HALISI MUHAMMAD LPC
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Gender | Male
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 09/27/2020
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Provider Practice Location Address
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Address Line | 5595 PAGE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63112-4118
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Country | US
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Telephone | 314-503-6248
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Fax | 949-655-8524
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Provider Business Mailing Address
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Address Line | 6322 VIRGINIA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63111-2434
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Country | US
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Telephone | 314-397-9661
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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 | 2014007785
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License Number State | MO
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