Provider Demographics
NPI:1730496605
Name:ST. LOUIS CENTER FOR FAMILY DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:ST. LOUIS CENTER FOR FAMILY DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPARGO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-750-4077
Mailing Address - Street 1:5461A GRAVOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2340
Mailing Address - Country:US
Mailing Address - Phone:314-353-1080
Mailing Address - Fax:314-353-8733
Practice Address - Street 1:5461A GRAVOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2340
Practice Address - Country:US
Practice Address - Phone:314-353-1080
Practice Address - Fax:314-353-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013676251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health