Individual
JERRY TABAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
109 CHURCH ST, SUITE 105, O FALLON, MO 63366-2894
(636) 294-0015
Mailing address
109 CHURCH ST, SUITE 105, O FALLON, MO 63366-2894
(636) 294-0015
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
002217
MO
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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