MEDICARE: BREATHE EASY MENTAL HEALTH 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1306567136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE EASY MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3206 N DAKOTA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 N DAKOTA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1231
Country	:	US
Telephone Number	:	314-941-7006
Fax Number	:

Authorized Official
Title or Position	:	LPC/OWNER
Name	:	MS. TOSHA PEARSON
Credential	:	LPC
Telephone Number	:	314-941-7006

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/09/2022

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