MEDICARE: OUROBOROS COUNSELING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1538988134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUROBOROS COUNSELING LLC

Provider Business Mailing Address
First Line	:	1123 LOCUST ST STE 237
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1103
Country	:	US
Telephone Number	:	361-945-8382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3449 S JEFFERSON AVE # 10
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3119
Country	:	US
Telephone Number	:	314-312-1206
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITAIN SHAW
Credential	:	LPC
Telephone Number	:	361-945-8382

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	03/16/2026

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