Individual
STACIE GORDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3751 PENNRIDGE DR STE 119, BRIDGETON, MO 63044-1244
(314) 744-9276
Mailing address
5522 MCLARAN AVE, SAINT LOUIS, MO 63136-1247
(314) 276-6196
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2015045059
MO
Other
Enumeration date
06/13/2016
Last updated
02/14/2024
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