| NPI | 1528420775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADA M. GALLUP Therapist 573-239-6642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 2016008293) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2016-03-27 |