Organization
IMAGE CHANGED COUNSELING AND CONSULTATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIA JENICE MORRIS MSW, ACSW, LCSW (OWNER/THERAPIST)
(314) 323-0463
Entity
Organization
Contact information
Practice address
225 S MERAMEC AVE, STE 218, CLAYTON, MO 63105-3511
(314) 323-0463
Mailing address
225 S MERAMEC AVE, STE 218, CLAYTON, MO 63105-3511
(314) 323-0463
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2010036934
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245532894
—
MO
Enumeration date
07/27/2011
Last updated
07/28/2011
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