MEDICARE: TSE PSYCHOLOGICAL SERVICES LLC

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
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1174343107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSE PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 430175
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-0275
Country	:	US
Telephone Number	:	314-270-2343
Fax Number	:

Provider Business Practice Location Address
First Line	:	7110 OAKLAND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1868
Country	:	US
Telephone Number	:	314-270-2343
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST/OWNER
Name	:	DR. TIMIKA SHERELL EDWARDS
Credential	:	PHD
Telephone Number	:	314-270-2343

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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