| NPI | 1114374634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Manager 636-466-6452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2023-07-04 |