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General NPI Number Information
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NPI Number | 1063695559
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE YOUTH CONNECTION
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 9530 WATSON INDUSTRIAL PARK
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1525
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Country | US
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Telephone | 314-963-8368
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Fax | 314-963-8935
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Provider Business Mailing Address
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Address Line | 9530 WATSON INDUSTRIAL PARK
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1525
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Country | US
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Telephone | 314-963-8368
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Fax | 314-963-8935
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MEG PETRI
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Credential | LPC
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Telephone | 314-963-8368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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