Healthcare Provider Details

I. General information

NPI: 1437437399
Provider Name (Legal Business Name): DESHAY OUTREACH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 HARLAN AVE
SAINT LOUIS MO
63147-2023
US

IV. Provider business mailing address

869 HARLAN AVE
SAINT LOUIS MO
63147-2023
US

V. Phone/Fax

Practice location:
  • Phone: 314-388-2356
  • Fax: 314-388-2534
Mailing address:
  • Phone: 314-388-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGARET A DESHAY
Title or Position: OWNER
Credential:
Phone: 314-388-2356