Healthcare Provider Details

I. General information

NPI: 1699470435
Provider Name (Legal Business Name): TOTAL HEALTH AND PRODUCTIVITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15235 BRIGHTFIELD MANOR DR
CHESTERFIELD MO
63017-2488
US

IV. Provider business mailing address

15235 BRIGHTFIELD MANOR DR
CHESTERFIELD MO
63017-2488
US

V. Phone/Fax

Practice location:
  • Phone: 636-236-9578
  • Fax:
Mailing address:
  • Phone: 636-236-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DALAVIRAS
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 636-236-9578