Provider Demographics
NPI:1003428269
Name:CMG- NEW SEASON- ST. LOUIS METRO TREATMENT CENTER
Entity Type:Organization
Organization Name:CMG- NEW SEASON- ST. LOUIS METRO TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-423-7030
Mailing Address - Street 1:9733 ST. CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114
Mailing Address - Country:US
Mailing Address - Phone:314-423-7030
Mailing Address - Fax:314-423-9511
Practice Address - Street 1:2500 MAITLAND CENTER PARKWAY 250
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-351-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMG- NEW SEASON- ST. LOUIS METRO TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty