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DARRELL PROVINSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
L.P.C.

Contact information

Practice address
9378 OLIVE BLVD, STE. 317, SAINT LOUIS, MO 63132-3215
(314) 994-9344
(314) 994-3007
Mailing address
9378 OLIVE BLVD, STE. 317, SAINT LOUIS, MO 63132-3215
(314) 994-9344
(314) 994-3007

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2004003789
MO

Other

Enumeration date
01/10/2007
Last updated
07/08/2007
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