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General NPI Number Information
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NPI Number | 1033677257
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Entity Type | Organization
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Legal Business Name | MIDWEST TRAUMA RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 2025 S BRENTWOOD BLVD STE 207
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City | SAINT LOUIS
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State | MO
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Zip | 63144-1851
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Country | US
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Telephone | 314-384-9748
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 S BRENTWOOD BLVD STE 207
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City | SAINT LOUIS
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State | MO
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Zip | 63144-1851
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Country | US
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Telephone | 314-384-9748
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | KRYSTAL MARIE SCHUETTE
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Credential | LPC
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Telephone | 314-384-9748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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