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Individual

MR. JUSTIN JEROME PHILLIPS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSW

Contact information

Practice address
4021 LACLEDE AVE # 23211, SAINT LOUIS, MO 63108-3271
(313) 724-2669
Mailing address
PO BOX 23211, SAINT LOUIS, MO 63156-3211
(313) 724-2669

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
01/31/2020
Last updated
01/31/2020
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