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NPI Code Detail

MEDICARE: DANIEL BERTILSON LPC

MEDICARE: DANIEL BERTILSON 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
1101YP2500XProfessional Counselor2026000784MO

General Provider Information

NPI Number : 1841916442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL BERTILSON LPC
Provider Business Mailing Address
First Line : 3530 UTAH ST APT 201
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-2751
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 S SKINKER BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-2317
Country : US
Telephone Number : 314-485-9330
Fax Number : 949-404-8756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2022
Last Update Date : 02/12/2026

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Directions to “ DANIEL BERTILSON LPC” Practice Location

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