| NPI | 1003146358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH CLEMSON President 314-276-5622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MO 2000165547) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MO 2000165547) |
| Enumeration Date | 2010-01-09 |
| Last Update Date | 2010-01-09 |