Healthcare Provider Details

I. General information

NPI: 1679110498
Provider Name (Legal Business Name): ST. LOUIS PLAY THERAPY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2019
Last Update Date: 12/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 LOCUST ST
SAINT LOUIS MO
63101-1103
US

IV. Provider business mailing address

1123 LOCUST ST
SAINT LOUIS MO
63101-1103
US

V. Phone/Fax

Practice location:
  • Phone: 314-240-5109
  • Fax: 314-492-4009
Mailing address:
  • Phone: 314-240-5109
  • Fax: 314-492-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APRIL DUNCAN
Title or Position: CO-OWNER
Credential: MSW, LCSW, RPT
Phone: 314-240-5109