| Bradke Counseling, Llc | |
|
103 Lincoln St O Fallon MO 63366-1603 | |
| (314) 477-6105 | |
| Not Available |
| Full Name | Bradke Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 103 Lincoln St, O Fallon, Missouri |
| Authorized Official Name and Position | Mackenzie Lee Lester (OWNER) |
| Authorized Official Contact | 3144776105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bradke Counseling, Llc 118 Whetstone Dr Saint Charles MO 63303-3026 Ph: (314) 477-6105 | Bradke Counseling, Llc 103 Lincoln St O Fallon MO 63366-1603 Ph: (314) 477-6105 |
| NPI Number | 1043707847 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 04/17/2018 |
| Medicare PECOS PAC ID | 8022372002 |
|---|---|
| Medicare Enrollment ID | O20180426002559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043707847 | NPI | - | NPPES |
| 497315507 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2005025550 (Missouri) | Primary |
| Provider Name | Mackenzie L Lester |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528072832 PECOS PAC ID: 0446529606 Enrollment ID: I20170630001161 |
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