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NPI Code Detail

MEDICARE: EPIR SOURCE MENTAL HEALTH SERVICES

MEDICARE: EPIR SOURCE MENTAL HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11003433202OTHERNPI
21912594664OTHERNPI
31629686381OTHERNPI

General Provider Information

NPI Number : 1073374989
Entity Type Code : Organization
Provider Name (Legal Business Name) : EPIR SOURCE MENTAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 819 AVONDALE DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-7835
Country : US
Telephone Number : 314-485-9241
Fax Number : 314-255-2501
Provider Business Practice Location Address
First Line : 911 WASHINGTON AVE STE 501
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63101-1272
Country : US
Telephone Number : 314-485-9241
Fax Number : 314-255-2501
Authorized Official
Title or Position : OWNER/OPERATOR
Name : LATRECE MARLENE SMITH
Credential : LCSW
Telephone Number : 314-485-9241
Provider Enumeration Date : 01/18/2024
Last Update Date : 01/18/2024

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Directions to “EPIR SOURCE MENTAL HEALTH SERVICES ” Practice Location

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