Provider Demographics
NPI:1922425107
Name:MUHAMMAD, HALISI (LPC)
Entity Type:Individual
Prefix:
First Name:HALISI
Middle Name:
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2434
Mailing Address - Country:US
Mailing Address - Phone:314-397-9661
Mailing Address - Fax:
Practice Address - Street 1:5595 PAGE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-4118
Practice Address - Country:US
Practice Address - Phone:314-503-6248
Practice Address - Fax:949-655-8524
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014007785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional