| NPI | 1821019936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN TILFORD Office Manager 314-205-8068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MO 3140-9189) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2013-03-01 |