Healthcare Provider Details

I. General information

NPI: 1235067182
Provider Name (Legal Business Name): RUBY A KNOX CRADC,MARS,MRSS,RPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9733 SAINT CHARLES ROCK RD
BRECKENRIDGE HILLS MO
63114-2625
US

IV. Provider business mailing address

8123 AIRPORT RD
SAINT LOUIS MO
63134-1907
US

V. Phone/Fax

Practice location:
  • Phone: 314-423-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: