Provider Demographics
NPI:1952401812
Name:COLLABORATIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:636-345-1400
Mailing Address - Street 1:1600 HERITAGE LANDING
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303
Mailing Address - Country:US
Mailing Address - Phone:636-345-1400
Mailing Address - Fax:636-441-3262
Practice Address - Street 1:1600 HERITAGE LANDING
Practice Address - Street 2:SUITE 116
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-345-1400
Practice Address - Fax:636-441-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty