Provider Demographics
NPI:1538699467
Name:SQUARE ONE COUNSELING, LLC
Entity Type:Organization
Organization Name:SQUARE ONE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SCHOPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:314-808-2346
Mailing Address - Street 1:2544 AUTUMN FIELDS LN
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3071
Mailing Address - Country:US
Mailing Address - Phone:314-808-2346
Mailing Address - Fax:636-277-9293
Practice Address - Street 1:920 BENT OAK CT STE B
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1485
Practice Address - Country:US
Practice Address - Phone:314-808-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490031754Medicaid