Provider Demographics
NPI:1619101482
Name:O'FALLON MARITAL & FAMILY COUNSELING AND WELLNESS CENTER
Entity Type:Organization
Organization Name:O'FALLON MARITAL & FAMILY COUNSELING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMFT
Authorized Official - Phone:636-294-4640
Mailing Address - Street 1:1137 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1498
Mailing Address - Country:US
Mailing Address - Phone:636-294-4640
Mailing Address - Fax:636-294-4641
Practice Address - Street 1:1137 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1498
Practice Address - Country:US
Practice Address - Phone:636-294-4640
Practice Address - Fax:636-294-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty