=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982724340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S ADVOCACY SERVICES OF GREATER ST. LOUIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 UNIVERSITY BLVD UMSL WEINMAN BLDG.
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63121-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-516-6798
-----------------------------------------------------
Fax | 314-516-6624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 UNIVERSITY BLVD UMSL WEINMAN BLDG.
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63121-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-516-6798
-----------------------------------------------------
Fax | 314-516-6624
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. JERRY DUNN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 314-516-6798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2001011555
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------