Active NPI
Enisa Balogun
- Mental Health Counselor
- St Louis, MO
National Provider Identifier
1013582196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2018038960
- Practice address
- 1349 Macklind Ave
Suite 200
St Louis, MO 63110 - Phone
- (314) 648-7800
- NPI assigned
- May 21, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2018038960 | MO | Primary |
Addresses
Primary practice location
1349 Macklind Ave
Suite 200
St Louis, MO 63110
Mailing address
1349 Macklind Ave
Suite 200
St Louis, MO 63110
Phone (314) 648-7800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018038960 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621555200000",
"number": "1013582196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1349 MACKLIND AVE",
"address_2": "SUITE 200",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-648-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1349 MACKLIND AVE",
"address_2": "SUITE 200",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-648-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALOGUN",
"first_name": "ENISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-21",
"last_updated": "2021-05-21",
"certification_date": "2021-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2018038960",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.