Does a med spa have to register or hold a license in Missouri?

Short answer
Not as a "med spa" — the cited rules only license cosmetology establishments: a spa where esthetics is performed must register before opening ($100 for up to three operators), and opening unregistered adds a $100 delinquent fee.

What these claims establish is person and school licensure, and — under the Board of Cosmetology and Barber Examiners’ own fee rule — premises licensure too: 20 CSR 2085-3.010(2)(C) prices a cosmetology establishment of up to three operators at $100 to license and $75 to renew, and separately prices opening one without registering first. The Board of Cosmetology and Barber Examiners exists for the purpose of licensing all persons engaged in the practice of cosmetology, manicuring, esthetics and barbering, and a school of cosmetology must obtain a license from the board before opening. The chapter defines a “cosmetology establishment” as that part of any building wherein any of the classified occupations are practiced, including space rented within a licensed establishment, and gives the board power to prescribe by rule for the INSPECTION of cosmetology establishments and schools and their sanitary conditions — but no claim on record here states a statutory establishment license, so a Missouri operator should confirm the premises requirement with the board or counsel. The apprenticeship route is set by hours per occupation: no less than three thousand hours for cosmetologists, eight hundred for manicurists and fifteen hundred for esthetics.