Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2013010229 | MO |
NPI | 1003212739 |
---|---|
Provider Name | Cristina Smugala |
First Address | Florissant, MO 63031-8017 |
Second Address | Clayton, MO 63105-3750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2014 |
Last Update Date | 06/08/2015 |