| Ebony Therapy Llc | |
|
3751 Pennridge Dr Ste 119 Bridgeton MO 63044-1244 | |
| (314) 791-2606 | |
| Not Available |
| Full Name | Ebony Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3751 Pennridge Dr Ste 119, Bridgeton, Missouri |
| Authorized Official Name and Position | Clara Genine Edwards (OFFICIAL DELEGATE) |
| Authorized Official Contact | 3147912606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebony Therapy Llc 3751 Pennridge Dr Ste 119 Bridgeton MO 63044-1244 Ph: (314) 443-7776 | Ebony Therapy Llc 3751 Pennridge Dr Ste 119 Bridgeton MO 63044-1244 Ph: (314) 791-2606 |
| NPI Number | 1679173108 |
|---|---|
| Provider Enumeration Date | 10/26/2020 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Medicare PECOS PAC ID | 0446699052 |
|---|---|
| Medicare Enrollment ID | O20240416001384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679173108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ebony Cheri Hutchinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033253208 PECOS PAC ID: 0648684472 Enrollment ID: I20210205001430 |
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