| NPI | 1992218549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN MARIE MOORE Therapist 573-673-0517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 2017035746) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2017-11-06 |