| NPI | 1932597721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN WYATT Member 573-433-2833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2012036248) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2013015853) | |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2017-04-13 |