Individual
JUAN ANTHONY TABB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9572 CROCKETT DR, SAINT LOUIS, MO 63132-2144
(314) 269-7885
Mailing address
9572 CROCKETT DR, SAINT LOUIS, MO 63132-2144
(314) 269-7885
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2017004506
MO
Other
Enumeration date
03/14/2017
Last updated
05/03/2019
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