Individual
TIFFANY A WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15455 CONWAY RD STE 117, CHESTERFIELD, MO 63017-2022
(636) 466-3077
Mailing address
15455 CONWAY RD STE 117, CHESTERFIELD, MO 63017-2022
(636) 466-3077
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2022037460
MO
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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