Individual
NATHANIEL TYLER BRACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
10805 SUNSET OFFICE DR STE 210, SAINT LOUIS, MO 63127-1026
(314) 626-0962
Mailing address
10805 SUNSET OFFICE DR STE 201, SAINT LOUIS, MO 63127-1026
(314) 626-0962
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2019012771
MO
Other
Enumeration date
03/08/2021
Last updated
09/28/2021
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