Healthcare Provider Details

I. General information

NPI: 1083390611
Provider Name (Legal Business Name): MIDWEST MUSIC THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S BRENTWOOD BLVD STE 119
SAINT LOUIS MO
63144-1337
US

IV. Provider business mailing address

6642 CLAYTON RD # 179
SAINT LOUIS MO
63117-1602
US

V. Phone/Fax

Practice location:
  • Phone: 314-960-0475
  • Fax:
Mailing address:
  • Phone: 314-960-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARIA RENEE CARRON
Title or Position: PRESIDENT/DIRECTOR OF SERVICES
Credential: MT-BC
Phone: 314-960-0475