Healthcare Provider Details

I. General information

NPI: 1023552858
Provider Name (Legal Business Name): OTHER ALTERNATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 WASHINGTON AVE STE. 500
SAINT LOUIS MO
63101-1243
US

IV. Provider business mailing address

911 WASHINGTON AVE STE. 500
SAINT LOUIS MO
63101-1243
US

V. Phone/Fax

Practice location:
  • Phone: 314-764-3408
  • Fax:
Mailing address:
  • Phone: 314-764-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number101Y00000X
License Number StateMO

VIII. Authorized Official

Name: MS. ALICIA M COLLIER
Title or Position: COUNSELOR
Credential: MS
Phone: 314-764-3408