MEDICARE: CENTER FOR COUNSELING AND PASTORAL CARE

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	101YP1600X	Pastoral Counselor	2004029338	MO
2	101YP2500X	Professional Counselor	180-000873	IL
3	101YP2500X	Professional Counselor	180-002690	IL
4	1041C0700X	Clinical Social Worker	2004029338	MO

General Provider Information

NPI Number	:	1770662199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR COUNSELING AND PASTORAL CARE

Provider Business Mailing Address
First Line	:	7680 LINDBERGH DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2138
Country	:	US
Telephone Number	:	636-527-7615
Fax Number	:	636-527-7635

Provider Business Practice Location Address
First Line	:	7680 LINDBERGH DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2138
Country	:	US
Telephone Number	:	636-527-7615
Fax Number	:	636-527-7635

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LINDA A. HORRELL
Credential	:	M.DIV, MSW
Telephone Number	:	636-527-7615

Provider Enumeration Date	:	11/05/2006
Last Update Date	:	10/19/2021

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