Organization
FORMING FRIENDSHIPS LLC
Active
Organization
FORMING FRIENDSHIPS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE A PETEFISH LCPC, BCBA, LBA (OWNER/BEHAVIOR ANALYST)
(314) 297-0793
Entity
Organization
Contact information
Practice address
171 ROBERTS DR, HILLSBORO, MO 63050-4120
(314) 297-0793
(314) 202-5441
Mailing address
171 ROBERTS DR, HILLSBORO, MO 63050-4120
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2015044940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500052076
—
MO
Enumeration date
10/30/2017
Last updated
03/13/2019
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