| NPI | 1811215528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON ROBERSON Lpc 636-294-5490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2010012405) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |