1083086474 NPI number — VERIA COUNSELING, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083086474 NPI number — VERIA COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERIA COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDELYN MINOR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083086474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63119-6226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-650-3905
Provider Business Mailing Address Fax Number:
314-890-2034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 WALL ST
Provider Second Line Business Practice Location Address:
SUITE 244
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63303-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-650-3905
Provider Business Practice Location Address Fax Number:
314-890-2034
Provider Enumeration Date:
10/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MINOR
Authorized Official First Name:
MEDELYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-650-3905

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2005009307 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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