| NPI | 1699470435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DALAVIRAS Administrator 636-236-9578 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-04-03 |