Healthcare Provider Details

I. General information

NPI: 1144713884
Provider Name (Legal Business Name): GREENBROOK TMS ST LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16091 SWINGLEY RIDGE RD STE 100
CHESTERFIELD MO
63017-2056
US

IV. Provider business mailing address

PO BOX 950603
SAINT LOUIS MO
63195-0603
US

V. Phone/Fax

Practice location:
  • Phone: 855-940-4867
  • Fax: 855-721-4867
Mailing address:
  • Phone: 855-711-4867
  • Fax: 641-800-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA WILLET
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 855-711-4867