MEDICARE: ASSOCIATES IN BEHAVIORAL HEALTH, LTD.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1720272990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN BEHAVIORAL HEALTH, LTD.

Provider Business Mailing Address
First Line	:	10805 SUNSET OFFICE DR
Second Line	:	SUITE 401
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1017
Country	:	US
Telephone Number	:	314-909-8484
Fax Number	:	314-909-8485

Provider Business Practice Location Address
First Line	:	10805 SUNSET OFFICE DR
Second Line	:	SUITE 401
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1017
Country	:	US
Telephone Number	:	314-909-8484
Fax Number	:	314-909-8485

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS NOWOTNY
Credential	:	MD
Telephone Number	:	314-909-8484

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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