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General NPI Number Information
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NPI Number | 1710191234
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Entity Type | Organization
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Legal Business Name | CRESTWOOD CONSULTANTS, INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10000 WATSON RD SUITE 2L18
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1854
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Country | US
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Telephone | 314-965-5451
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Fax | 314-965-5451
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Provider Business Mailing Address
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Address Line | 12151 LOWILL LN
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City | SAINT LOUIS
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State | MO
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Zip | 63126-2900
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Country | US
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Telephone | 314-965-5451
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Fax | 314-842-7904
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. YVONNE ICYLEEN DEHART
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Credential | M.ED.
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Telephone | 314-965-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CS000370
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License Number State | MO
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