Organization Name: | LET'S TALK TEEN CLINIC INC. |
NPI Number: | 1164860375 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STAISY YOUNG (NURSE PRACTITIONER) |
Mailing Address: | 119 Church Street Suite 131 Ferguson |
State: | MO US |
Postal Code: | 63135 |
Phone Number: | 3144942584 |
Fax Number: | |
NPI Enumeration Date: | 06/10/2013 |
NPI Last Update Date: | 10/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | 2002031370 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |