Healthcare Provider Details

I. General information

NPI: 1992833545
Provider Name (Legal Business Name): CHRISTINA MELIN LARRIGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WOLFRUM RD SUTIE 201, ROOM 204
WELDON SPRING MO
63304-7898
US

IV. Provider business mailing address

212 BROUGHAM DR
O FALLON MO
63368-8002
US

V. Phone/Fax

Practice location:
  • Phone: 636-442-5674
  • Fax: 636-442-5601
Mailing address:
  • Phone: 636-244-8708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004030919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: