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General NPI Number Information
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NPI Number | 1851068175
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Entity Type | Organization
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Legal Business Name | ST. LOUIS PLAY THERAPY, LLC
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 9962 LIN FERRY DR STE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6961
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Country | US
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Telephone | 314-240-5109
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Fax |
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Provider Business Mailing Address
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Address Line | 3629 RUSSELL BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3705
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Country | US
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Telephone | 314-550-7451
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN WALSH SMITHSON
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Credential | LCSW
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Telephone | 314-550-7451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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