Individual
MATT FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
1 BROOKINGS DRIVE, SEIGLE HALL, STE 435, ST. LOUIS, MO 63130-4889
(314) 935-8457
Mailing address
4049 W PINE BLVD APT 103, SAINT LOUIS, MO 63108-3237
(314) 372-9738
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2020022837
MO
Other
Enumeration date
08/12/2020
Last updated
02/23/2022
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