Healthcare Provider Details

I. General information

NPI: 1760453682
Provider Name (Legal Business Name): JOAN A. HELLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 CARONDELET AVE STE 527
CLAYTON MO
63105-0008
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD SUITE 1601
SAINT LOUIS MO
63117-1223
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-1415
  • Fax: 314-725-1378
Mailing address:
  • Phone: 314-725-1415
  • Fax: 314-725-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01449
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: