MEDICARE: MR. DAVID BROWN GALT JR. M.A.

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	101YP2500X	Professional Counselor	2001007636	MO

General Provider Information

NPI Number	:	1659437101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID BROWN GALT JR. M.A.

Provider Business Mailing Address
First Line	:	1124 S 18TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2912
Country	:	US
Telephone Number	:	314-436-7864
Fax Number	:	314-436-8003

Provider Business Practice Location Address
First Line	:	4231 LACLEDE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2814
Country	:	US
Telephone Number	:	314-436-8003
Fax Number	:	314-436-8003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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