Ebony Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EBONY THERAPY LLC

Practice address

3751 Pennridge Dr Ste 119
Bridgeton, MO 63044-1244

Phone

(314) 791-2606

NPI assigned

Oct 26, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Clara Genine Edwards, CPC

Title

Official Delegate

Phone

(314) 791-2606

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

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

• Ebony Cheri Hutchinson, PLCSW

  • Clinical Social Worker
  • Saint Louis, MO
  • NPI 1033253208
  Medicare reassignment NPD

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

{
    "created_epoch": "1603670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1679173108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3751 PENNRIDGE DR STE 119",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630441244",
            "telephone_number": "314-443-7776",
            "fax_number": "314-735-4377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3751 PENNRIDGE DR STE 119",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630441244",
            "telephone_number": "314-791-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONY THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-26",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "GENINE",
        "authorized_official_title_or_position": "OFFICIAL DELEGATE",
        "authorized_official_telephone_number": "314-791-2606",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Dunn, PHARM.D
• CHI Duong-Nguyen, RPH
• Tessa Durell
• Megan E Durham, BA
• Kaitlynn Dutzy
• Ellen Lockard Edens, MD, MPE, MA
• Terry R Egan, DDS
• Teide Brisibe Ehimare, M.D.
• Norman J Ehlinger Jr., DO
• Craig Gerard Elinor, DMD

• Clinical Social Worker in Bridgeton, MO
• Providers in Bridgeton, 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 Nov 17, 2020; 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.