Organization
EPIR SOURCE MENTAL HEALTH SERVICES
Active
Parent organization
EPIR SOURCE MENTAL HEALTH SERVICES
Other names
EPIR Source LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EPIR SOURCE MENTAL HEALTH SERVICES
Authorized official
LATRECE MARLENE SMITH LCSW (OWNER/OPERATOR)
(314) 485-9241
Entity
Organization
Contact information
Practice address
911 WASHINGTON AVE STE 501, SAINT LOUIS, MO 63101-1272
(314) 485-9241
(314) 255-2501
Mailing address
819 AVONDALE DR, SAINT PETERS, MO 63376-7835
(314) 485-9241
(314) 255-2501
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003433202
NPI
—
01
—
1629686381
NPI
—
01
—
1912594664
NPI
—
Enumeration date
01/18/2024
Last updated
01/18/2024
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