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General NPI Number Information
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NPI Number | 1831377464
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Entity Type | Organization
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Legal Business Name | EATING DISORDER RECOVERY CENTER
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD SUITE 694
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1223
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Country | US
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Telephone | 314-721-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD SUITE 694
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1223
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Country | US
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Telephone | 314-721-5514
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DEBORAH JOY KUEHNEL
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Credential | LCSW
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Telephone | 314-721-5514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6196-9774
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License Number State | MO
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