Healthcare Provider Details

I. General information

NPI: 1225964158
Provider Name (Legal Business Name): ELDRIDGE FAMILY PSYCHIATRY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 RIVERVIEW RD # 1074
CLEVER MO
65631-6282
US

IV. Provider business mailing address

231 S BEMISTON AVE STE 850
SAINT LOUIS MO
63105-1920
US

V. Phone/Fax

Practice location:
  • Phone: 417-818-5506
  • Fax:
Mailing address:
  • Phone: 417-216-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLGA ANATOLYEVNA ELDRIDGE
Title or Position: OWNER/APRN
Credential: PMHNP-BC
Phone: 417-818-5506