Provider Demographics
NPI:1992504674
Name:DYNAMITE COACH STL LLC
Entity type:Organization
Organization Name:DYNAMITE COACH STL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WININGAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-443-1337
Mailing Address - Street 1:10121 SAINT MARTHA LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2911
Mailing Address - Country:US
Mailing Address - Phone:314-443-1334
Mailing Address - Fax:
Practice Address - Street 1:745 CRAIG RD STE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7122
Practice Address - Country:US
Practice Address - Phone:314-443-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMITE COACH STL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty