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General NPI Number Information
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NPI Number | 1679301824
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Entity Type | Organization
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Legal Business Name | CONQUER THE CHANGE THERAPY, LLC
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 12747 OLIVE BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6269
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Country | US
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Telephone | 314-217-6980
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Fax |
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Provider Business Mailing Address
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Address Line | 12747 OLIVE BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6269
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Country | US
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Telephone | 314-217-6980
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE PEROTTA
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Credential | LMSW
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Telephone | 314-409-3113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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