Healthcare Provider Details

I. General information

NPI: 1528552320
Provider Name (Legal Business Name): CHRISTINA RENEE BROWN CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 SUNRIDGE DR APT D
SAINT LOUIS MO
63125-3472
US

IV. Provider business mailing address

1 JEFFERSON BARRACKS DR
SAINT LOUIS MO
63125-4181
US

V. Phone/Fax

Practice location:
  • Phone: 601-918-3697
  • Fax:
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-894-5792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number50784
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: