Provider Demographics
NPI:1043802077
Name:PROFECTUS COUNSELING, LLC
Entity Type:Organization
Organization Name:PROFECTUS COUNSELING, LLC
Other - Org Name:GREENWAY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAREN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:800-353-6402
Mailing Address - Street 1:230 S BEMISTON AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1907
Mailing Address - Country:US
Mailing Address - Phone:314-482-7510
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 920
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-482-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty