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General NPI Number Information
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NPI Number | 1619472099
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Entity Type | Organization
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Legal Business Name | GATEWAY MENTAL WELLNESS
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 1715 DEER TRACKS TRL STE 260
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1855
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Country | US
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Telephone | 314-363-9385
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Fax | 314-394-1404
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Provider Business Mailing Address
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Address Line | 709 PERRY ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2945
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Country | US
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Telephone | 309-838-1888
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MOLLY CHRISTINE THOMAS
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Credential |
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Telephone | 309-838-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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