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1550 Wall St Suite 244 Saint Charles MO 63303-3545 | |
| (314) 650-3905 | |
| (314) 890-2034 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1550 Wall St, Saint Charles, Missouri |
| Authorized Official Name and Position | Medelyn Minor (OWNER) |
| Authorized Official Contact | 3146503905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 190226 Saint Louis MO 63119-6226 Ph: (314) 650-3905 | 1550 Wall St Suite 244 Saint Charles MO 63303-3545 Ph: (314) 650-3905 |
| NPI Number | 1083086474 |
|---|---|
| Provider Enumeration Date | 10/23/2015 |
| Last Update Date | 10/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083086474 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2005009307 (Missouri) | Primary |
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