| NPI | 1154070175 |
|---|---|
| Other Name | NONE |
| Entity Type | Organization |
| Authorized Contact | ALEXANDER SHLAFSHTEYN Member 314-504-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2022-12-05 |