Courtney Rydstrom, MA, LPC, RPT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2017039214 Issued in MO

Practice address

1001 Boardwalk Springs PL Ste 113
O Fallon, MO 63368-4777

Phone

(314) 322-3229

NPI assigned

Feb 2, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1580601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580601600000",
    "number": "1851922488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 TUXEDO BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631191840",
            "telephone_number": "314-322-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BOARDWALK SPRINGS PL STE 113",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633684777",
            "telephone_number": "314-322-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYDSTROM",
        "first_name": "COURTNEY",
        "credential": "MA, LPC, RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-02",
        "last_updated": "2020-02-02",
        "certification_date": "2020-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2017039214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.