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General NPI Number Information
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NPI Number | 1568913564
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Entity Type | Organization
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Legal Business Name | ST. PATRICK CENTER
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 800 N TUCKER BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1000
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Country | US
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Telephone | 314-802-1958
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Fax | 314-802-1980
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Provider Business Mailing Address
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Address Line | 800 N TUCKER BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1000
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Country | US
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Telephone | 314-802-1958
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Fax | 314-802-1980
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MS. MAUREEN THERESE HENTZ
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Credential | MA, LPC
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Telephone | 314-802-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | MO
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