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Organization

YOUTHCENTRIX THERAPY SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PAMELA LONG (MANAGER)
(469) 662-6729
Entity
Organization

Contact information

Practice address
11630 HELENOAK DR, BLACK JACK, MO 63033-7226
(314) 877-8754
Mailing address
11630 HELENOAK DR, BLACK JACK, MO 63033-7226

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
225X00000X
Occupational Therapist
Primary
225XM0800X
Mental Health Occupational Therapist
225XN1300X
Neurorehabilitation Occupational Therapist
225XP0019X
Physical Rehabilitation Occupational Therapist
225XP0200X
Pediatric Occupational Therapist

Other

Enumeration date
12/29/2016
Last updated
12/29/2016
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