| NPI | 1336810548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARAH LYNN SHADDIX Owner/Provider 636-306-1330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |