Provider Demographics
NPI:1811207996
Name:REACHING BACK ENTEPRISE LLC
Entity Type:Organization
Organization Name:REACHING BACK ENTEPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-489-9517
Mailing Address - Street 1:P.O. 211115
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-9998
Mailing Address - Country:US
Mailing Address - Phone:314-489-9517
Mailing Address - Fax:314-383-1564
Practice Address - Street 1:14220 OLD HALLS FERRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2400
Practice Address - Country:US
Practice Address - Phone:314-489-9517
Practice Address - Fax:314-383-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health