# INTEGRATED NEUROSCIENCE, LLC

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

## Provider details

- **NPI number:** 1740580315
- **Authorized official:** MR. JOHN PALMER CRUM LCPC (CLINICAL DIRECTOR)
- **Authorized official phone:** (314) 997-2296

## Contact information

- **Practice address:** 11477 OLDE CABIN RD, SUITE 210, SAINT LOUIS, MO 63141-7130
- **Practice address phone:** (314) 997-2296
- **Practice address fax:** (314) 997-5368
- **Mailing address:** 11477 OLDE CABIN RD, SUITE 210, SAINT LOUIS, MO 63141-7130
- **Mailing address phone:** (314) 997-2296
- **Mailing address fax:** (314) 997-5368

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 2007012895 | MO | Yes |

## Other

- **Enumeration date:** 10/28/2010
- **Last updated:** 10/28/2010