Organization
IMYND CONNECTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ELIZABETH STEVENSON MOORE MSW, LCSW (OWNER)
(314) 606-1265
Entity
Organization
Contact information
Practice address
745 CRAIG RD STE 104, CREVE COEUR, MO 63141-7122
(314) 606-1265
Mailing address
745 CRAIG RD STE 104, CREVE COEUR, MO 63141-7122
(314) 606-1265
(314) 202-6016
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/20/2020
Last updated
05/11/2020
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