MEDICARE: MINISTERING AMONG RIGHTEOUS YOUTH

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		MO

General Provider Information

NPI Number	:	1982123097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINISTERING AMONG RIGHTEOUS YOUTH

Provider Business Mailing Address
First Line	:	9615 DURHAM DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1353
Country	:	US
Telephone Number	:	314-565-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	10451 ROYAL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6039
Country	:	US
Telephone Number	:	314-565-1110
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. CHANNEL GENISE THOMAS
Credential	:	M.ED,PLPC,NBCC,LLC
Telephone Number	:	314-565-1110

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	09/11/2017

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Directions to “MINISTERING AMONG RIGHTEOUS YOUTH ” Practice Location

Language	Start Address	Practice Location

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