Individual
MS. JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1000 EXECUTIVE PARKWAY DR, SUITE 120, SAINT LOUIS, MO 63141-6325
(314) 737-0020
Mailing address
15 FORSYTHIA LN, OLIVETTE, MO 63132-2003
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2014027206
MO
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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