MEDICARE: PROFESSIONAL COUNSELING CONNECTIONS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417583360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL COUNSELING CONNECTIONS

Provider Business Mailing Address
First Line	:	3021 HIGHWAY A STE 104
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5498
Country	:	US
Telephone Number	:	314-323-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021 HIGHWAY A STE 104
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5498
Country	:	US
Telephone Number	:	314-323-8592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REBECCA RALSTON
Credential	:
Telephone Number	:	314-323-8592

Provider Enumeration Date	:	03/22/2020
Last Update Date	:	03/22/2020

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