AUTHENTIC CHANGE COUNSELING LLC (NPI# 1033536263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033536263 |
| Entity Type | Organization |
| Organization Name | AUTHENTIC CHANGE COUNSELING LLC |
| Practice Address |
425 Marshall Ave Saint Louis MO 63119-1833 |
| Practice Telephone | 3145185112 |
| Practice Fax Number | 3149637703 |
| Mailing Telephone | 3145185112 |
| Mailing Fax Number | 3149637703 |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2014-03-26 |
| Authorized Official Name | JESSICA KIESLER (OWNER, MANAGER) |
| Authorized Official Telephone | 3144884680 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
3927 | MO | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
2006036528 | MO | Behavioral Health & Social Service Providers |
| Street Address |
425 MARSHALL AVE |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63119-1833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073706008 | Gwin Michelle Stewart | Psychologist | 425 Marshall Ave, Saint Louis, MO 63119-1833 | 2007-08-22 |
| 1710446380 | Ashley Wiegand | Marriage & Family Therapist | 425 Marshall Ave, Saint Louis, MO 63119-1833 | 2019-03-13 |
| 1922545847 | Kimberly Jane Probst Warden | Social Worker | 425 Marshall Ave, Saint Louis, MO 63119-1833 | 2017-01-30 |
| 1508302035 | Kemberlee Mahaffey | Social Worker | 425 Marshall Ave, Saint Louis, MO 63119-1833 | 2017-01-08 |
| 1831353317 | Jessica Kiesler | Counselor | 425 Marshall Ave, Saint Louis, MO 63119-1833 | 2008-07-15 |
| 1376713933 | Center for Hope LLC | Psychologist | 425 Marshall Ave, Saint Louis, MO 63119-1833 | 2008-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114525631 | Kaylen A Howard | Specialist/Technologist | No, No, MO 63119 | 2020-10-16 |
| 1053887612 | St. Gianna Pediatrics, LLC | Pediatrics | 7387 Watson Road, Shrewsbury, MO 63119 | 2018-10-22 |
| 1982140265 | Forefront Dermatology, S.c. | Dermatology | 8567 Watson Rd, Webster Groves, MO 63119 | 2017-01-11 |
| 1407308018 | Tyler Clark | Student in an Organized Health Care Education/Training Program | 7785 Keswick Pl, Saint Louis, MO 63119 | 2016-10-30 |
| 1396109880 | Ritesh Gandhi | Family Medicine | 7345 Watson Rd Ste 203, Saint Louis, MO 63119 | 2016-04-11 |
| 1568834489 | Antonio Robinson | Counselor | 330 N. Gore, Great Circle, Saint Louis, MO 63119 | 2015-10-30 |
| 1922484039 | Odessa Baker X | Dietary Manager | 525 N. Laclede Station Road, St. Louis, MO 63119 | 2015-07-31 |
| 1194114694 | Laura Maher | Social Worker | 201 W. Lockwood Ave, Suite 201, St. Louis, MO 63119 | 2015-01-21 |
| 1427314046 | Dick (richard) Ralph Brummett | Family Medicine | 711 S Laclede Sta Rd, # 2111, St Louis, MO 63119 | 2012-04-09 |
| 1972872935 | Dolliene A. Raabe | Social Worker | 8050 Watson Road, Suite 201, St. Louis, MO 63119 | 2011-12-21 |
| Find all providers in zip 63119 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841899374 | Christopher Seigel | Counselor | 5317 Mild Dr, Saint Louis, MO 63129-3109 | 2020-10-26 |
| 1467067504 | Anne Margaret Perkins | Counselor | 9733 Saint Charles Rock Rd, Saint Louis, MO 63114-2625 | 2020-09-15 |
| 1730792722 | Aryn Bostic | Counselor | 7584 Olive Blvd Ste 203, Saint Louis, MO 63130-1600 | 2020-08-28 |
| 1417568932 | Child and Family Empowerment Center | Counselor | 800 N Tucker Blvd Fl 1, Saint Louis, MO 63101-1008 | 2020-08-10 |
| 1720603830 | Kelly Marie Buckley | Counselor | 5939 Hilgard Pl, Saint Louis, MO 63109-3445 | 2020-06-15 |
| 1407479207 | Lauren Elizabeth Summers | Counselor | 6261 Reber Pl, Saint Louis, MO 63139-2617 | 2020-05-27 |
| 1306469960 | Walter Robert Scull | Counselor | 1300 Kirkham Ave, Saint Louis, MO 63122-3127 | 2020-05-18 |
| 1982226759 | David Mcgraw | Counselor | 28 Reasor Dr, Saint Louis, MO 63135-1125 | 2020-05-14 |
| 1992326565 | Chantrell M Carter | Counselor | 5027 Mardel Ave, Saint Louis, MO 63109-1731 | 2020-05-05 |
| 1508486333 | Evelyn Aviva Witten | Counselor | 130 S Bemiston Ave Ste 604, Saint Louis, MO 63105-1913 | 2020-04-22 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63119 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.