| NPI | 1982973053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY R FINTEL Sole Member 314-725-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO LC1185766) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |