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General NPI Number Information
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NPI Number | 1093531295
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Entity Type | Organization
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Legal Business Name | UNLOCKING POTENTIAL WITHIN, LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 7110 OAKLAND AVE STE 105
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1870
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Country | US
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Telephone | 314-391-5465
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Fax | 314-227-9327
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Provider Business Mailing Address
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Address Line | 1176 HILLARD RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3256
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Country | US
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Telephone | 352-359-1482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW WISLOCKI
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Credential | PHD
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Telephone | 352-359-1482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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