NPIMap

Organization Active NPI

Family Life Counseling and Psychological Services, LLC

  • Psychologist
  • O Fallon, MO
National Provider Identifier
1851459473
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2000166718 Issued in MO
Legal business name
FAMILY LIFE COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Practice address
4142 Keaton Crossing Blvd Ste 101
O Fallon, MO 63368-8406
Phone
(636) 300-9333
Fax
(636) 300-8761
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

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

Authorized official

Name
Mr. David Sanderson
Title
Manager
Phone
(636) 300-9333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 2000166718 MO Primary

Addresses

Primary practice location

4142 Keaton Crossing Blvd Ste 101
O Fallon, MO 63368-8406

Mailing address

6700 Keaton Corporate Pkwy Ste 101
O Fallon, MO 63368-8636
Phone (636) 300-9333

Other practice location 1

6700 Keaton Corporate Pkwy Ste 101
O Fallon, MO 63368-8636
Phone (636) 300-9333

Other identifiers 1

IdentifierTypeStateIssuer
165530OtherMOBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000722 MO Part B Supplier - Clinic/Group Practice 5496649022 Receives reassigned benefits from 5 practitioners
Practice locations: O Fallon, MO

National Provider Directory

National Provider Directory

Locations

6700 Keaton Corporate Pkwy
Ste 101
O Fallon, MO 63368

4142 Keaton Crossing Blvd
Ste 101
O Fallon, MO 63368
Phone (636) 300-9333

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1851459473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 KEATON CORPORATE PKWY STE 101",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688636",
            "telephone_number": "636-300-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4142 KEATON CROSSING BLVD STE 101",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688406",
            "telephone_number": "636-300-9333",
            "fax_number": "636-300-8761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6700 Keaton Corporate Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "MO",
            "postal_code": "633688636",
            "country_code": "US",
            "telephone_number": "636-300-9333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY LIFE COUNSELING AND PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A",
        "authorized_official_last_name": "SANDERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "636-300-9333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2000166718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "165530",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; 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.