Provider Demographics
NPI:1518035245
Name:GAFFORD, SALLY HITT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:HITT
Last Name:GAFFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:LIGON
Other - Last Name:HITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 S NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 129W
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-997-4963
Mailing Address - Fax:314-997-8874
Practice Address - Street 1:777 S NEW BALLAS ROAD
Practice Address - Street 2:SUITE 129W
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-997-4963
Practice Address - Fax:314-997-8874
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOCS001102101YP2500X
MOMOMF300104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist