| Shanti Source Counseling Llc | |
|
11042 Manchester Rd Kirkwood MO 63122-1244 | |
| (314) 202-6867 | |
| Not Available |
| Full Name | Shanti Source Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 11042 Manchester Rd, Kirkwood, Missouri |
| Authorized Official Name and Position | Cindy Haller (OWNER) |
| Authorized Official Contact | 3142026867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shanti Source Counseling Llc 2183 Wide Oak Ct Chesterfield MO 63017-7226 Ph: (314) 541-1198 | Shanti Source Counseling Llc 11042 Manchester Rd Kirkwood MO 63122-1244 Ph: (314) 202-6867 |
| NPI Number | 1962031385 |
|---|---|
| Provider Enumeration Date | 04/07/2020 |
| Last Update Date | 04/07/2020 |
| Certification Date | 04/07/2020 |
| Medicare PECOS PAC ID | 7214367739 |
|---|---|
| Medicare Enrollment ID | O20200424001622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962031385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Cindy Haller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083074876 PECOS PAC ID: 7911235890 Enrollment ID: I20190830000988 |
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