Healthcare Provider Details

I. General information

NPI: 1982123097
Provider Name (Legal Business Name): MINISTERING AMONG RIGHTEOUS YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 ROYAL DR
SAINT LOUIS MO
63136-6039
US

IV. Provider business mailing address

9615 DURHAM DR
SAINT LOUIS MO
63137-1353
US

V. Phone/Fax

Practice location:
  • Phone: 314-565-1110
  • Fax:
Mailing address:
  • Phone: 314-565-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. CHANNEL GENISE THOMAS
Title or Position: THERAPIST
Credential: M.ED,PLPC,NBCC,LLC
Phone: 314-565-1110