| NPI | 1922792076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE JAQUES CEO 314-560-7063 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-06-28 |