Healthcare Provider Details

I. General information

NPI: 1699821132
Provider Name (Legal Business Name): THE LEARNING TREE INTERG.CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 LABADIE AVE
SAINT LOUIS MO
63115-2603
US

IV. Provider business mailing address

4430 LABADIE AVE
SAINT LOUIS MO
63115-2603
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-0699
  • Fax:
Mailing address:
  • Phone: 314-534-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number575
License Number StateMO

VIII. Authorized Official

Name: SHIRLEY BLACK
Title or Position: DIRECTOR
Credential:
Phone: 314-534-0699