Individual
COLLEEN MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
10845 OLIVE BLVD, SAINT LOUIS, MO 63141-7760
(314) 561-6757
Mailing address
7011 SUTHERLAND AVE, SAINT LOUIS, MO 63109-1919
(314) 807-7354
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2013042521
MO
Other
Enumeration date
06/07/2017
Last updated
06/07/2017
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