| NPI | 1376327205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HATTIE DEBORD Nurse Practitioner 636-538-5422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-05-08 |