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COTTLEVILLE, MO
NPI1144040130
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: MO  2021037533)
Enumeration Date2024-10-14
Last Update Date2024-10-14
Business Address
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5498 SAINT CHARLES ST
COTTLEVILLE, MO 63304-8020
Phone number: 636-556-0867
Mailing Address
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1341 POINT MARINER DR
FENTON, MO 63026-6918
Phone number: 314-604-1357
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