| Mattis Road Counseling, Llc | |
|
5151 Mattis Rd Ste C Saint Louis MO 63128-2796 | |
| (314) 952-2947 | |
| Not Available |
| Full Name | Mattis Road Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5151 Mattis Rd Ste C, Saint Louis, Missouri |
| Authorized Official Name and Position | Peter D Kopcha (OWNER) |
| Authorized Official Contact | 3143342335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mattis Road Counseling, Llc 5151 Mattis Rd Ste C Saint Louis MO 63128-2796 Ph: (314) 334-2335 | Mattis Road Counseling, Llc 5151 Mattis Rd Ste C Saint Louis MO 63128-2796 Ph: (314) 952-2947 |
| NPI Number | 1184215501 |
|---|---|
| Provider Enumeration Date | 01/28/2021 |
| Last Update Date | 09/28/2022 |
| Certification Date | 09/28/2022 |
| Medicare PECOS PAC ID | 8527474717 |
|---|---|
| Medicare Enrollment ID | O20210315000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184215501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Peter D Kopcha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164011722 PECOS PAC ID: 9436565629 Enrollment ID: I20210315000086 |
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