| NPI | 1790814309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL FREDRICK DETRICK President 314-837-7828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 000043) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 001427) |
| 103T00000X Psychologist (Licence: MO 00843) | |
| 103T00000X Psychologist (Licence: MO 2006029901) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |