Individual
MICHAEL HIGGINBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
11582 TIVOLI LN, SAINT LOUIS, MO 63146-3500
(314) 692-7830
Mailing address
11582 TIVOLI LN, SAINT LOUIS, MO 63146-3500
(314) 692-7830
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004063
MO
Other
Enumeration date
10/13/2009
Last updated
10/13/2009
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