Healthcare Provider Details

I. General information

NPI: 1982724340
Provider Name (Legal Business Name): CHILDREN'S ADVOCACY SERVICES OF GREATER ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY BLVD UMSL WEINMAN BLDG.
SAINT LOUIS MO
63121-4400
US

IV. Provider business mailing address

1 UNIVERSITY BLVD UMSL WEINMAN BLDG.
SAINT LOUIS MO
63121-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-6798
  • Fax: 314-516-6624
Mailing address:
  • Phone: 314-516-6798
  • Fax: 314-516-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001011555
License Number StateMO

VIII. Authorized Official

Name: DR. JERRY DUNN
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 314-516-6798