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Behavioral Health & Social Service Providers Counselor Professional

Provider NPI: 1861746638

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
1137 N MAIN ST #2 O FALLON, MO 63366-1498 US
Tel: 636-294-4640  Fax: --

Business Mailing Address:
Tel: 314-298-0186  Fax: --

NPI Information:
NPI: 1861746638
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YP2500XBehavioral Health & Social Service Providers
N101YS0200XBehavioral Health & Social Service Providers
N103TS0200XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 101YP2500X





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