Foundations For Change, Llc | |
3115 S Grand Blvd St. Louis MO 63118 | |
(314) 577-0444 | |
Not Available |
Full Name | Foundations For Change, Llc |
---|---|
Speciality | Counselor - Professional |
Location | 3115 S Grand Blvd, St. Louis, Missouri |
Authorized Official Name and Position | Alexandria C. Boyer (PARTNER) |
Authorized Official Contact | 3145770444 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Foundations For Change, Llc 3115 S Grand Blvd St. Louis MO 63118 Ph: (314) 577-0444 | Foundations For Change, Llc 3115 S Grand Blvd St. Louis MO 63118 Ph: (314) 577-0444 |
NPI Number | 1952650442 |
---|---|
Provider Enumeration Date | 08/30/2012 |
Last Update Date | 08/30/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952650442 | NPI | - | NPPES |
133624356 | Medicaid | MO | |
1861703944 | Medicaid | MO | |
1144578519 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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