Provider Demographics
NPI:1033677257
Name:MIDWEST TRAUMA RECOVERY CENTER
Entity Type:Organization
Organization Name:MIDWEST TRAUMA RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-384-9748
Mailing Address - Street 1:3611 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6332
Mailing Address - Country:US
Mailing Address - Phone:314-384-9748
Mailing Address - Fax:
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 555
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1265
Practice Address - Country:US
Practice Address - Phone:314-384-9748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)