Basic Information
| Provider Information | |||||||||
| NPI: | 1386064251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDER | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 OLD SOUTH RIVER RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633034120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362241210 | ||||||||
| FaxNumber: | 6362461008 | ||||||||
| Practice Location | |||||||||
| Address1: | 1628 OKLAHOMA AVE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646832565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6603594600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2014 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2013026543 | MO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 2016035072 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.