Provider Demographics
NPI:1811248537
Name:COUNSELING ST. CHARLES, LLC
Entity type:Organization
Organization Name:COUNSELING ST. CHARLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-294-0015
Mailing Address - Street 1:109 CHURCH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2894
Mailing Address - Country:US
Mailing Address - Phone:636-294-0015
Mailing Address - Fax:
Practice Address - Street 1:109 CHURCH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2894
Practice Address - Country:US
Practice Address - Phone:636-294-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002217OtherDIVISION OF PROFESSIONAL REGISTRATION