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General NPI Number Information
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NPI Number | 1972799914
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS COUNSELING, LC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 1200 S LINDBERGH BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2923
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Country | US
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Telephone | 314-432-7927
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Fax | 314-991-1242
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Provider Business Mailing Address
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Address Line | 1200 S LINDBERGH BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2923
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Country | US
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Telephone | 314-432-7927
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Fax | 314-991-1242
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Authorized Official
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Title or Position | PARTNER
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Name | VIRGINIA A IVES
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Credential | LCSW, MSW
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Telephone | 314-432-7927
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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 | 000112
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License Number State | MO
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