Healthcare Provider Details

I. General information

NPI: 1952169179
Provider Name (Legal Business Name): ST. LOUIS BEHAVIORAL MEDICINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SALEM PLACE STE 225A FAIRVIEW EXECUTIVE PLAZA II
FAIRVIEW HEIGHTS IL
62208
US

IV. Provider business mailing address

1129 MACKLIND AVE
SAINT LOUIS MO
63110-1440
US

V. Phone/Fax

Practice location:
  • Phone: 618-825-0051
  • Fax:
Mailing address:
  • Phone: 314-881-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3300