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Organization
ANNIE MALONE CHILDREN AND FAMILY SERVICE CENTER
Active
Organization
ANNIE MALONE CHILDREN AND FAMILY SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANNEL GENISE THOMAS M.ED. LPC TF-CBT NCC (DIRECTOR OF CLINICAL AND OUTPATIENT)
(314) 565-1110
Entity
Organization
Contact information
Practice address
5355 PAGE AVENUE, ST. LOUIS, MO 63112
(314) 531-0120
(314) 531-0125
Mailing address
2612 ANNIE MALONE DRIVE, ST. LOUIS, MO 63113
(314) 531-0120
(314) 531-0125
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
SEO200902
MO
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
002136058
MO
385H00000X
Respite Care
001305902
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942449194
—
MO
05
—
506278209
—
MO
Enumeration date
02/11/2009
Last updated
02/05/2020
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