Individual
MUDAR SOUFIAN ISMAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLPC
Contact information
Practice address
4030 CHOUTEAU AVE STE 700, SAINT LOUIS, MO 63110-1754
(314) 680-9374
(314) 645-7802
Mailing address
701 TREESIDE CT APT I, CHESTERFIELD, MO 63017-0716
(636) 856-7505
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2024010478
MO
Other
Enumeration date
07/25/2024
Last updated
07/25/2024
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