| NPI | 1750818225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANA D CRYSTAL Owner 314-308-7772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2017-05-16 |