| NPI | 1972129179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ERNEST WARDLOW Owner/Therapist 573-915-4123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-04-07 |