| NPI | 1366911711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA MOYE Enrollment Specialist 636-224-1210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2018-11-20 |