| NPI | 1932778974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISABELLE BOUCHARD Part Owner 573-615-4656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |