Provider Demographics
NPI:1063246353
Name:LEVEL UP COUNSELING
Entity type:Organization
Organization Name:LEVEL UP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIESTELKAMP (RICKERT)
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:618-444-8021
Mailing Address - Street 1:4618 SEIBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-5809
Mailing Address - Country:US
Mailing Address - Phone:618-444-8021
Mailing Address - Fax:
Practice Address - Street 1:74 GRASSO PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-3108
Practice Address - Country:US
Practice Address - Phone:618-444-8021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty