Intentional Living Psychotherapy LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

INTENTIONAL LIVING PSYCHOTHERAPY LLC

Practice address

3200 Chouteau Ave
Saint Louis, MO 63103-2910

Phone

(314) 827-4051

NPI assigned

Dec 30, 2020

Last updated

Dec 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexis Evans, LPCNPI 1982026910

Title

Owner

Phone

(314) 458-4016

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexis Evans, LPC

  • Mental Health Counselor
  • Black Jack, MO
  • NPI 1982026910
  NPD Authorized official

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1770170268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12425 BIELEFELD LN",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630334255",
            "telephone_number": "314-458-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CHOUTEAU AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032910",
            "telephone_number": "314-827-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL LIVING PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-458-4016",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.