MEDICARE: MIDWEST MUSIC THERAPY SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1083390611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST MUSIC THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	6642 CLAYTON RD # 179
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1602
Country	:	US
Telephone Number	:	314-960-0475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 S BRENTWOOD BLVD STE 119
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1337
Country	:	US
Telephone Number	:	314-960-0475
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR OF SERVICES
Name	:	MARIA RENEE CARRON
Credential	:	MT-BC
Telephone Number	:	314-960-0475

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	06/27/2023

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