MEDICARE: ALLISON REICHERT MED LPC 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1740829266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLISON REICHERT MED LPC LLC

Provider Business Mailing Address
First Line	:	10820 SUNSET OFFICE DR STE 204
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1030
Country	:	US
Telephone Number	:	314-563-1330
Fax Number	:	314-315-4896

Provider Business Practice Location Address
First Line	:	2521 CECELIA AVE.
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2514
Country	:	US
Telephone Number	:	314-563-1330
Fax Number	:

Authorized Official
Title or Position	:	OWNER, SOLE MEMBER
Name	:	KATHRYN ALLISON TAYLOR-REICHERT
Credential	:	MED, LPC, NCC
Telephone Number	:	314-563-1330

Provider Enumeration Date	:	01/01/2020
Last Update Date	:	09/29/2020

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