1225641673 NPI number — UNITED CHRISTIAN COUNSELING SERVICE LLC PhD MFT Noah Jameel Henderson Dr. Henderson Dr

Table of content: PhD MFT Noah Jameel Henderson Dr. Henderson Dr (NPI 1225641673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225641673 NPI number — UNITED CHRISTIAN COUNSELING SERVICE LLC PhD MFT Noah Jameel Henderson Dr. Henderson Dr

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED CHRISTIAN COUNSELING SERVICE LLC
Provider Last Name:
Henderson
Provider First Name:
Noah
Provider Middle Name:
Jameel
Provider Name Prefix Text:
PhD MFT
Provider Name Suffix Text:
Dr. Henderson
Provider Credential Text:
Dr
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1225641673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7733 FORSYTH BLVD FL 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-1878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-485-9298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7733 FORSYTH BLVD FL 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63105-1878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-485-9298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LYLES PHD MFT
Authorized Official First Name:
NOAH
Authorized Official Middle Name:
PHD
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
314-485-9298

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com