Organization
ANNIE MALONE CHILDREN AND FAMILY SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANNEL GENISE THOMAS M.ED. LPC TF-CBT NCC (DIRECTOR OF CLINICAL AND OUTPATIENT)
(314) 565-1110
Entity
Organization
Contact information
Practice address
5355 PAGE AVENUE, ST. LOUIS, MO 63112
(314) 531-0120
(314) 531-0125
Mailing address
2612 ANNIE MALONE DRIVE, ST. LOUIS, MO 63113
(314) 531-0120
(314) 531-0125
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
SEO200902
MO
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
002136058
MO
385H00000X
Respite Care
001305902
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942449194
—
MO
05
—
506278209
—
MO
Enumeration date
02/11/2009
Last updated
02/05/2020
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