Shanti Source Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SHANTI SOURCE COUNSELING LLC

Practice address

11042 Manchester Rd
Kirkwood, MO 63122-1244

Phone

(314) 202-6867

NPI assigned

Apr 7, 2020

Organization subpart

No

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

Authorized official

Name

Cindy Haller, LCSWNPI 1083074876

Title

Owner

Phone

(314) 202-6867

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

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

• Cindy Haller, LCSW

  • Social Worker
  • Chesterfield, MO
  • NPI 1083074876
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586217600000",
    "number": "1962031385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2183 WIDE OAK CT",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630177226",
            "telephone_number": "314-541-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11042 MANCHESTER RD",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631221244",
            "telephone_number": "314-202-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANTI SOURCE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-07",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A",
        "authorized_official_last_name": "HALLER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-202-6867",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Kirkwood, MO
• Providers in Kirkwood, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; 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.