Provider Demographics
NPI:1588057350
Name:KARIS HOUSE COMMUNITY COUSNELING CENTER
Entity type:Organization
Organization Name:KARIS HOUSE COMMUNITY COUSNELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-802-8805
Mailing Address - Street 1:2811 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1006
Mailing Address - Country:US
Mailing Address - Phone:314-802-8805
Mailing Address - Fax:314-255-1852
Practice Address - Street 1:2811 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1006
Practice Address - Country:US
Practice Address - Phone:314-802-8805
Practice Address - Fax:314-255-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty