MEDICARE: ST. LOUIS ADDICTION 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	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1568700276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS ADDICTION COUNSELING LLC

Provider Business Mailing Address
First Line	:	7954 BIG BEND BLVD
Second Line	:	SUITE E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7954 BIG BEND BLVD
Second Line	:	SUITE E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2717
Country	:	US
Telephone Number	:	314-677-7808
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. ANTHONY DAVID ZEHNLE
Credential	:
Telephone Number	:	314-435-6963

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	01/30/2013

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