Healthcare Provider Details

I. General information

NPI: 1588057350
Provider Name (Legal Business Name): KARIS HOUSE COMMUNITY COUSNELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1006
US

IV. Provider business mailing address

2811 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1006
US

V. Phone/Fax

Practice location:
  • Phone: 314-802-8805
  • Fax: 314-255-1852
Mailing address:
  • Phone: 314-802-8805
  • Fax: 314-255-1852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HENDERICKSON
Title or Position: ADMINSTRATOR
Credential:
Phone: 314-802-8805