Individual
KELLY LARKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
811 CORVALLIS CT., ELLISVILLE, MO 63021-4767
(314) 941-0875
Mailing address
811 CORVALLIS CT, ELLISVILLE, MO 63021-4767
(314) 941-0875
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2016019115
MO
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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