MEDICARE: ROSEBUD FAMILY CONSULTANTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2001031938	MO
2	1041C0700X	Clinical Social Worker	SW001311	MO

General Provider Information

NPI Number	:	1003080979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEBUD FAMILY CONSULTANTS

Provider Business Mailing Address
First Line	:	1360 S 5TH ST
Second Line	:	SUITE 346
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2449
Country	:	US
Telephone Number	:	636-724-2922
Fax Number	:	636-724-2928

Provider Business Practice Location Address
First Line	:	1360 S 5TH ST
Second Line	:	SUITE 346
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2449
Country	:	US
Telephone Number	:	636-724-2922
Fax Number	:	636-724-2928

Authorized Official
Title or Position	:	PARTNER
Name	:	PAUL ALLEN BRAUTIGAM
Credential	:	LPC, NCC
Telephone Number	:	636-724-2922

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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