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NPI Code Detail

MEDICARE: WHITE STONE PSYCHOLOGICAL SERVICES LLC

MEDICARE: WHITE STONE 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1548868821
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE STONE PSYCHOLOGICAL SERVICES LLC
Provider Business Mailing Address
First Line : 613 BIG BEND RD # 857
Second Line :
City : MANCHESTER
State : MO
Zip : 63021-9998
Country : US
Telephone Number : 314-915-2233
Fax Number :
Provider Business Practice Location Address
First Line : 613 BIG BEND RD # 857
Second Line :
City : MANCHESTER
State : MO
Zip : 63021-9998
Country : US
Telephone Number : 314-915-2233
Fax Number :
Authorized Official
Title or Position : PSYCHOLOGIST
Name : DR. MALLORY LAMB
Credential : PSY.D.
Telephone Number : 314-915-2233
Provider Enumeration Date : 10/09/2020
Last Update Date : 10/05/2023

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Directions to “WHITE STONE PSYCHOLOGICAL SERVICES LLC ” Practice Location

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