Mattis Road Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MATTIS ROAD COUNSELING, LLC

Practice address

5151 Mattis Rd Ste C
Saint Louis, MO 63128-2796

Phone

(314) 952-2947

NPI assigned

Jan 28, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Peter D Kopcha, LCSWNPI 1164011722

Title

Owner

Phone

(314) 334-2335

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter Kopcha, LCSW

  • Clinical Social Worker
  • Saint Louis, MO
  • NPI 1164011722
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1184215501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 MATTIS RD STE C",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282796",
            "telephone_number": "314-334-2335",
            "fax_number": "314-334-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 MATTIS RD STE C",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282796",
            "telephone_number": "314-952-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTIS ROAD COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "KOPCHA",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-334-2335",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mattingly Chiropractic
• Dustan J. Mattingly, D.C.
• Lauren Drbul Mattingly, PNP
• Maureen Ann Mattingly, M.S., CCC-SLP
• Tori Marie Mattingly, FNP
• Mattis Road Surgery Center LLC
• Ross Mattox, D.C.
• Consuelo Maturana, LPC
• George M. Matuschak, M.D.
• Rachel Ann Matusiak, M.S., R.D., L.D.

• Clinical Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.