Organization
GREENLEAF THERACARE IOP, LLC
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEXANDER SHLAFSHTEYN (MEMBER)
(314) 504-0404
Entity
Organization
Contact information
Practice address
10199 WOODFIELD LN, SAINT LOUIS, MO 63132-2922
(314) 504-0404
Mailing address
10199 WOODFIELD LN, SAINT LOUIS, MO 63132-2922
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/18/2022
Last updated
12/05/2022
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