| Organization Name: | PROVIDENT |
| NPI Number: | 1104924745 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIA M WATKINS (COUNSELOR) |
| Mailing Address: | 3675 W Outer Rd Ste 203 Arnold |
| State: | MO US |
| Postal Code: | 630105232 |
| Phone Number: | 3148980102 |
| Fax Number: | 6362963249 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | 2002014019 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |