| Nystrom Counseling Mo, Pc | |
|
801 S Woodlawn Ave Ste 16 O Fallon MO 63366-7647 | |
| (636) 379-1779 | |
| Not Available |
| Full Name | Nystrom Counseling Mo, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 801 S Woodlawn Ave Ste 16, O Fallon, Missouri |
| Authorized Official Name and Position | Ann Eiden (VP OF CORPORATE SERVICES) |
| Authorized Official Contact | 6513791750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nystrom Counseling Mo, Pc 1900 Silver Lake Rd Nw New Brighton MN 55112-1786 Ph: () - | Nystrom Counseling Mo, Pc 801 S Woodlawn Ave Ste 16 O Fallon MO 63366-7647 Ph: (636) 379-1779 |
| NPI Number | 1184401762 |
|---|---|
| Provider Enumeration Date | 09/08/2023 |
| Last Update Date | 09/08/2023 |
| Certification Date | 09/08/2023 |
| Medicare PECOS PAC ID | 6103264494 |
|---|---|
| Medicare Enrollment ID | O20240405000535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184401762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kenneth A Barrett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609059468 PECOS PAC ID: 6002863461 Enrollment ID: I20050407000342 |
| Provider Name | Joseph A Daus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487653259 PECOS PAC ID: 6901922962 Enrollment ID: I20100927001352 |
| Provider Name | Kathleen M Wilde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831764760 PECOS PAC ID: 8426457342 Enrollment ID: I20210526002100 |
| Provider Name | Andrea Schramm |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447662309 PECOS PAC ID: 9335597038 Enrollment ID: I20231117002523 |
| Provider Name | Sean Reilly |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376146126 PECOS PAC ID: 1153779855 Enrollment ID: I20231117002540 |
| Provider Name | Ivan Milicevic |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568159085 PECOS PAC ID: 3678921376 Enrollment ID: I20231117002641 |
| Provider Name | Jason Kirkpatrick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013230853 PECOS PAC ID: 2668820366 Enrollment ID: I20231117002687 |
| Provider Name | Lauren Josten |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578252805 PECOS PAC ID: 2062860778 Enrollment ID: I20231117002992 |
| Provider Name | Angela Kuhns |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649738170 PECOS PAC ID: 1557719218 Enrollment ID: I20231120000889 |
| Provider Name | Tonya Lindsley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780231845 PECOS PAC ID: 6507214277 Enrollment ID: I20231120001168 |
| Provider Name | Pamela Fox |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588217962 PECOS PAC ID: 2668820333 Enrollment ID: I20231120001271 |
| Provider Name | Heather Bruce |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285322065 PECOS PAC ID: 4082062302 Enrollment ID: I20231128001197 |
| Provider Name | Robert Lindsley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336770296 PECOS PAC ID: 5294183273 Enrollment ID: I20231201000417 |
| Provider Name | Rachel Kloppe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679112973 PECOS PAC ID: 2466800339 Enrollment ID: I20231204000570 |
| Provider Name | Jean Harmon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578714341 PECOS PAC ID: 2264880012 Enrollment ID: I20231205000338 |
| Provider Name | Kaitlyn A Hagee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811650773 PECOS PAC ID: 4486004389 Enrollment ID: I20231219000224 |
| Provider Name | Minami Steele |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609303460 PECOS PAC ID: 0143597815 Enrollment ID: I20240109001674 |
| Provider Name | Andrea Wood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477022861 PECOS PAC ID: 3577916469 Enrollment ID: I20240126002595 |
| Provider Name | Alexandra N Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992563548 PECOS PAC ID: 1355780669 Enrollment ID: I20240419001275 |
| Provider Name | Fredrik Christoffer Lowenhielm |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245082486 PECOS PAC ID: 1153761580 Enrollment ID: I20240501003311 |
| Provider Name | Leah Elaine Tucker |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1952164840 PECOS PAC ID: 6901248996 Enrollment ID: I20240522001353 |
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