Organization
COUNSELING ST. CHARLES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON ROBERSON LPC (OWNER)
(636) 294-0015
Entity
Organization
Contact information
Practice address
225 S MAIN ST, STE 103, O FALLON, MO 63366-2866
(636) 294-0015
Mailing address
PO BOX 486, O FALLON, MO 63366-0486
(636) 294-0015
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2010012405
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093015257
INDIVIDUAL NPI
MO
Enumeration date
08/06/2012
Last updated
08/06/2012
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