| NPI | 1982928065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK LESTER CROUGHAN President 314-725-4004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO R5543) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MO R5543) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |