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General NPI Number Information
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NPI Number | 1861125130
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Entity Type | Organization
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Legal Business Name | HOUSE OF JOY
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 1047 S BIG BEND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1605
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Country | US
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Telephone | 314-329-5886
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Fax |
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Provider Business Mailing Address
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Address Line | 734 KINGSLAND AVE APT 3S
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-3108
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Country | US
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Telephone | 314-221-9318
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOY CISKOWSKI
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Credential | MA, LPC
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Telephone | 314-329-5886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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