| NPI | 1770873002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Manager 636-466-6452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2023-07-04 |