MEDICARE: MATTHEW MORGAN HENDERSON COUNSELING LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144087792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW MORGAN HENDERSON COUNSELING LLC

Provider Business Mailing Address
First Line	:	4912 PERSHING PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1202
Country	:	US
Telephone Number	:	314-978-8953
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 DUNCAN AVE STE 201
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1103
Country	:	US
Telephone Number	:	314-978-8953
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW HENDERSON
Credential	:	LCSW
Telephone Number	:	314-978-8953

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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