Healthcare Provider Details

I. General information

NPI: 1790013860
Provider Name (Legal Business Name): FAMILY THERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 BENTLEY PARK CIR
O FALLON MO
63368-8022
US

IV. Provider business mailing address

932 BENTLEY PARK CIR
O FALLON MO
63368-8022
US

V. Phone/Fax

Practice location:
  • Phone: 314-406-5209
  • Fax:
Mailing address:
  • Phone: 314-406-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number00856862
License Number StateMO

VIII. Authorized Official

Name: MRS. TRISHA LOCHER
Title or Position: PRESIDENT
Credential: MOT, OTR/L
Phone: 314-406-5209