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General NPI Number Information
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NPI Number | 1497040505
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Entity Type | Individual
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Provider Name | DAVID STAIR
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Gender | Male
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 1715 DEER TRACKS TRL SUITE 260
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1839
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Country | US
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Telephone | 636-541-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HILLCREST BLVD
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City | BALLWIN
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State | MO
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Zip | 63021-5255
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2011010750
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License Number State | MO
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