Healthcare Provider Details

I. General information

NPI: 1376713933
Provider Name (Legal Business Name): CENTER FOR HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MARSHALL AVE
SAINT LOUIS MO
63119-1833
US

IV. Provider business mailing address

425 MARSHALL AVE
SAINT LOUIS MO
63119-1833
US

V. Phone/Fax

Practice location:
  • Phone: 314-963-7711
  • Fax: 314-963-7703
Mailing address:
  • Phone: 314-963-7711
  • Fax: 314-963-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2002011104
License Number StateMO

VIII. Authorized Official

Name: GWIN STEWAART
Title or Position: OWNER
Credential: PH.D., CASAC
Phone: 314-724-0503