Individual
LOREN GAILLARDETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3008 SUTTON BLVD STE 200, MAPLEWOOD, MO 63143-3064
(314) 328-4402
Mailing address
6365 CLAYTON RD, CLAYTON, MO 63117-1808
(314) 328-4402
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2019009357
MO
Other
Enumeration date
09/24/2020
Last updated
08/06/2021
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