Organization
FAMILY SUPPORT NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUANITA WALLACE MA LPC (FAMILY THERAPIST)
(314) 644-5055
Entity
Organization
Contact information
Practice address
7514 BIG BEND BLVD, SAINT LOUIS, MO 63119-2104
(314) 644-5055
(314) 644-5057
Mailing address
570 SHACKELFORD RD, FLORISSANT, MO 63031-5457
(314) 830-1796
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
2002006418
MO
Other
Enumeration date
02/23/2007
Last updated
08/22/2020
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