Active NPI
Rodney Clossum, MA
- Professional Counselor
- St Charles, MO
National Provider Identifier
1821744947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2005028055
- Practice address
- 1360 South Fifth Street Suite 286
St Charles, MO 63301 - Phone
- (314) 971-4714
- NPI assigned
- Feb 28, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2005028055 | MO | Primary |
Addresses
Primary practice location
1360 South Fifth Street Suite 286
St Charles, MO 63301
Mailing address
629 Clemens Court
Kirkwood, MO 63122
Phone (314) 971-4714
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005028055 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646006400000",
"number": "1821744947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 CLEMENS COURT",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "63122",
"telephone_number": "314-971-4714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1360 SOUTH FIFTH STREET SUITE 286",
"city": "ST CHARLES",
"state": "MO",
"postal_code": "63301",
"telephone_number": "314-971-4714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLOSSUM",
"first_name": "RODNEY",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-28",
"last_updated": "2022-02-28",
"certification_date": "2022-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2005028055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.