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General NPI Number Information
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NPI Number | 1619101482
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Entity Type | Organization
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Legal Business Name | O'FALLON MARITAL & FAMILY COUNSELING AND WELLNESS CENTER
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 1137 N MAIN ST SUITE 2
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City | O FALLON
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State | MO
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Zip | 63366-1498
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Country | US
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Telephone | 636-294-4640
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Fax | 636-294-4641
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Provider Business Mailing Address
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Address Line | 1137 N MAIN ST SUITE 2
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City | O FALLON
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State | MO
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Zip | 63366-1498
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Country | US
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Telephone | 636-294-4640
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Fax | 636-294-4641
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Authorized Official
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Title or Position | PRESIDENT, CLINICAL DIRECTOR
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Name | DR. PATRICIA ANN ROWAN
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Credential | DMFT
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Telephone | 636-294-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2009005905
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License Number State | MO
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