MEDICARE: SAFE HARBOR COUNSELING OF MISSOURI, 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	:	1871358093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR COUNSELING OF MISSOURI, LLC

Provider Business Mailing Address
First Line	:	3106 PEARL HARBOR DR
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-3809
Country	:	US
Telephone Number	:	314-704-2541
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 PEARL HARBOR DR
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-3809
Country	:	US
Telephone Number	:	314-704-2541
Fax Number	:

Authorized Official
Title or Position	:	OWNER / LEAD THERAPIST
Name	:	MR. MICHAEL MASON
Credential	:	M.ED. LPC, NCC
Telephone Number	:	314-704-2541

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/16/2024

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