# COVENANT HOUSE MISSOURI

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467781393
- **Authorized official:** MS. KRISTINA R KERSTING MALPC (CLINICAL COORDINATOR)
- **Authorized official phone:** (314) 450-7667

## Contact information

- **Practice address:** 2727 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1006
- **Practice address phone:** (314) 450-7667
- **Practice address fax:** (314) 454-0005
- **Mailing address:** 2727 N. KINGSHIGHWAY BOULEVARD, ST. LOUIS, MO 63113
- **Mailing address phone:** (314) 450-7667
- **Mailing address fax:** (314) 454-0005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 2004036418 | MO | Yes |

## Other

- **Enumeration date:** 12/24/2009
- **Last updated:** 12/24/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1457324485 | NPI | MO |
| 05 | — | 499019503 | — | MO |