Ebony Therapy LLC
NPI 1679173108ActiveOrganization· Social Worker, Clinical· Bridgeton, MO
Social Worker, Clinical in Bridgeton, Missouri, registered in NPPES in October 2020. The authorized official on file is Clara Genine Edwards, CPC, Official Delegate. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1679173108 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 26, 2020 |
| Last updated in NPPES | Nov 17, 2020 |
| Certified by provider | Nov 17, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
| Psychologist, Clinical | 103TC0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MO) |
|---|
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