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

Table of content: MR. MICHAEL J JEWELL PTA (NPI 1972579597)

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)





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