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General NPI Number Information
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NPI Number | 1932586740
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Entity Type | Organization
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Legal Business Name | C KATKE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 2200 W PORT PLAZA DR STE 326
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3214
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Country | US
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Telephone | 314-548-2121
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Fax | 636-333-4510
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Provider Business Mailing Address
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Address Line | 15455 MANCHESTER RD UNIT 161
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City | BALLWIN
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State | MO
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Zip | 63022-5008
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Country | US
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Telephone | 314-548-2121
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Fax | 314-548-2121
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTY KATKE
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Credential | MSW, LCSW
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Telephone | 314-548-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW005494
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License Number State | MO
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