MEDICARE: HAPPY BRAIN COUNSELING, L.L.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942615588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY BRAIN COUNSELING, L.L.C.

Provider Business Mailing Address
First Line	:	12166 OLD BIG BEND RD STE 102
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6836
Country	:	US
Telephone Number	:	314-717-0190
Fax Number	:	314-754-7275

Provider Business Practice Location Address
First Line	:	12166 OLD BIG BEND RD STE 102
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6836
Country	:	US
Telephone Number	:	314-717-0190
Fax Number	:	314-754-7275

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	CAMILLE REINHOLD
Credential	:	L.P.C., M.B.A.
Telephone Number	:	314-717-0190

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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