MEDICARE: COMMUNITY WELLNESS COUNSELING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548863459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY WELLNESS COUNSELING

Provider Business Mailing Address
First Line	:	1726 NICHOLSON PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2614
Country	:	US
Telephone Number	:	636-219-5211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 NICHOLSON PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2614
Country	:	US
Telephone Number	:	636-219-5211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE M HIGH
Credential	:	LPC
Telephone Number	:	636-219-5211

Provider Enumeration Date	:	11/21/2020
Last Update Date	:	11/21/2020

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