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General NPI Number Information
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NPI Number | 1649862913
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Entity Type | Individual
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Provider Name | ALLISON GANNON
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 10880 BAUR BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1632
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Country | US
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Telephone | 314-471-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 5357 AUTUMNWINDS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63129-3005
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Country | US
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Telephone | 314-471-6463
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2019016754
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License Number State | MO
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