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Organization
COVENANT HOUSE MISSOURI
Active
Organization
COVENANT HOUSE MISSOURI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTINA R KERSTING MALPC (CLINICAL COORDINATOR)
(314) 450-7667
Entity
Organization
Contact information
Practice address
2727 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1006
(314) 450-7667
(314) 454-0005
Mailing address
2727 N. KINGSHIGHWAY BOULEVARD, ST. LOUIS, MO 63113
(314) 450-7667
(314) 454-0005
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
2004036418
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457324485
NPI
MO
05
—
499019503
—
MO
Enumeration date
12/24/2009
Last updated
12/24/2009
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