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1480 Woodstone Dr Ste 112 Saint Charles MO 63304-6872 | |
| (636) 477-6500 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1480 Woodstone Dr Ste 112, Saint Charles, Missouri |
| Authorized Official Name and Position | Brenda Lorraine Bryant (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6364776500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
293 Tyndale Dr O Fallon MO 63366-7553 Ph: (636) 544-6039 | 1480 Woodstone Dr Ste 112 Saint Charles MO 63304-6872 Ph: (636) 477-6500 |
| NPI Number | 1780051862 |
|---|---|
| Provider Enumeration Date | 08/25/2015 |
| Last Update Date | 08/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780051862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2010016700 (Missouri) | Primary |
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