MEDICARE: ST. LOUIS COUNSELING CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1700342813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS COUNSELING CENTER

Provider Business Mailing Address
First Line	:	709 PERRY ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2945
Country	:	US
Telephone Number	:	309-838-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 DEER TRACKS TRL STE 260
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1855
Country	:	US
Telephone Number	:	314-452-0896
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MOLLY CHRISTINE THOMAS
Credential	:
Telephone Number	:	309-838-1888

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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