| NPI | 1780136945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK JACOBSEN Owner 314-914-5762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2007031620) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |