Provider Information for 1225386055
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SARA KHALEDPOUR LPC
Sex: Female
NPI: 1225386055
Last Updated: 2024-03-19
Certification Date: 2024-03-19
Certification Date: 2024-03-19
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225386055 | ||||||||||||
| Enumeration Date | 2012-08-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 400 N 5TH ST STE 201 SAINT CHARLES, MO 63301-1808 United States Phone: 636-238-2615 | Fax: | ||||||||||||
| Primary Practice Address | 400 N 5TH ST STE 201 SAINT CHARLES, MO 63301-1808 United States Phone: 636-238-2615 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 6918 WINDSOR AVE | ||||||||||||
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