MEDICARE: NASEBO A COLEMAN-ROBINSON MA, PLPC, CRC,

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	2023009033	MO

General Provider Information

NPI Number	:	1114628450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASEBO A COLEMAN-ROBINSON MA, PLPC, CRC,

Provider Business Mailing Address
First Line	:	5615 PERSHING AVE STE 26
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1757
Country	:	US
Telephone Number	:	314-361-0477
Fax Number	:	314-361-3771

Provider Business Practice Location Address
First Line	:	5615 PERSHING AVE STE 26
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1757
Country	:	US
Telephone Number	:	314-361-0477
Fax Number	:	314-361-3771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2023
Last Update Date	:	03/14/2023

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