Active NPI
Victoria Bougeno
- Mental Health Counselor
- Saint Louis, MO
National Provider Identifier
1710835160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2026011328
- Practice address
- 50 Crestwood Executive Ctr Ste 308
Saint Louis, MO 63126-1900 - Phone
- (314) 408-7676
- Fax
- (314) 328-5453
- NPI assigned
- Mar 20, 2026
- 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 | 2026011328 | MO | Primary |
Addresses
Primary practice location
50 Crestwood Executive Ctr Ste 308
Saint Louis, MO 63126-1900
Mailing address
50 Crestwood Executive Ctr Ste 308
Saint Louis, MO 63126-1900
Phone (314) 408-7676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12818 Tesson Ferry Rd
Suite 103
Saint Louis, MO 63128-2945
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2026011328 | MO | MD | Mental Health Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788220800000",
"number": "1710835160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 CRESTWOOD EXECUTIVE CTR STE 308",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631261900",
"telephone_number": "314-408-7676",
"fax_number": "314-328-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 CRESTWOOD EXECUTIVE CTR STE 308",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631261900",
"telephone_number": "314-408-7676",
"fax_number": "314-328-5453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUGENO",
"first_name": "VICTORIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-20",
"last_updated": "2026-09-01",
"certification_date": "2026-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2026011328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.