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4144 Lindell Blvd Suite 402 St Louis MO 63108 | |
| (314) 531-1601 | |
| (314) 727-1921 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4144 Lindell Blvd, St Louis, Missouri |
| Authorized Official Name and Position | Orenza John Cotton (PRESIDENT) |
| Authorized Official Contact | 3145311600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1569 Quendo Avenue St Louis MO 63130-1419 Ph: (314) 727-7277 | 4144 Lindell Blvd Suite 402 St Louis MO 63108 Ph: (314) 531-1601 |
| NPI Number | 1003062936 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 09/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003062936 | NPI | - | NPPES |
| 2000165478 | Other | MO | LCSW MARRIAGE & FAMILY THERAPY |
| 495945404 | Medicaid | MO | |
| 856261409 | Medicaid | MO | |
| 856261409 | Other | MO | MEDICAID WAIVER |
| CASAC 2513 | Other | MO | ADDICTION DIAGNOSIS & TREARMENT |
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