MEDICARE: ALICIA NICOLE CUNNINGHAM LPC

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	101YP2500X	Professional Counselor	2017041097	MO

General Provider Information

NPI Number	:	1568979888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA NICOLE CUNNINGHAM LPC

Provider Business Mailing Address
First Line	:	4433 WOODSON RD STE 120C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-3713
Country	:	US
Telephone Number	:	314-261-3044
Fax Number	:	888-501-0347

Provider Business Practice Location Address
First Line	:	4433 WOODSON RD STE 120C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-3713
Country	:	US
Telephone Number	:	314-261-3044
Fax Number	:	888-501-0347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	06/12/2026

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