Organization
MMCMLLC
Active
Other names
Mantality Health
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY HARDMAN (CREDENTIALING MANAGER)
(314) 254-2420
Entity
Organization
Contact information
Practice address
4173 CRESCENT DR STE A, SAINT LOUIS, MO 63129-1082
(314) 254-2420
Mailing address
4173 CRESCENT DR STE A, SAINT LOUIS, MO 63129-1082
(314) 254-2420
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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