| NPI | 1407906803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL PROVINSE Executive Director 314-994-9344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2004003789) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |