Organization
FAMILY LIFE COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SANDERSON (MANAGER)
(636) 300-9333
Entity
Organization
Contact information
Practice address
4142 KEATON CROSSING BLVD, SUITE 101, O FALLON, MO 63368-8404
(636) 300-9333
(636) 300-8761
Mailing address
4142 KEATON CROSSING BLVD, SUITE 101, O FALLON, MO 63368-8404
(636) 300-9333
(636) 300-8761
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2000166718
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165530
BLUE CROSS BLUE SHIELD
MO
Enumeration date
12/05/2006
Last updated
04/10/2024
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