| St Louis Individual And Family Therapy Llc | |
|
1034 S Brentwood Blvd Ste 555 Richmond Heights MO 63117-1265 | |
| (314) 252-0392 | |
| Not Available |
| Full Name | St Louis Individual And Family Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1034 S Brentwood Blvd Ste 555, Richmond Heights, Missouri |
| Authorized Official Name and Position | Joanna Dalakos (OWNER) |
| Authorized Official Contact | 3142520392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Louis Individual And Family Therapy Llc 5409 Chapelford Ln Saint Louis MO 63119-5021 Ph: (314) 252-0392 | St Louis Individual And Family Therapy Llc 1034 S Brentwood Blvd Ste 555 Richmond Heights MO 63117-1265 Ph: (314) 252-0392 |
| NPI Number | 1679113401 |
|---|---|
| Provider Enumeration Date | 01/09/2020 |
| Last Update Date | 03/31/2020 |
| Certification Date | 03/31/2020 |
| Medicare PECOS PAC ID | 0042648107 |
|---|---|
| Medicare Enrollment ID | O20200324001206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679113401 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joanna T Dalakos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801193396 PECOS PAC ID: 6002156551 Enrollment ID: I20190319002551 |
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