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Organization

COVENANT HOUSE MISSOURI

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. KRISTINA R KERSTING MALPC (CLINICAL COORDINATOR)
(314) 450-7667
Entity
Organization

Contact information

Practice address
2727 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1006
(314) 450-7667
(314) 454-0005
Mailing address
2727 N. KINGSHIGHWAY BOULEVARD, ST. LOUIS, MO 63113
(314) 450-7667
(314) 454-0005

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
2004036418
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1457324485
NPI
MO
05
499019503
MO
Enumeration date
12/24/2009
Last updated
12/24/2009
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