| NPI | 1902430135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GLENN Clinical Director 314-392-3822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2020-03-31 |