Healthcare Provider Details

I. General information

NPI: 1477365716
Provider Name (Legal Business Name): MAJESTIC BRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 02/02/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 CRAIG RD STE 206
CREVE COEUR MO
63141-7122
US

IV. Provider business mailing address

745 CRAIG RD STE 206
CREVE COEUR MO
63141-7122
US

V. Phone/Fax

Practice location:
  • Phone: 314-782-7216
  • Fax:
Mailing address:
  • Phone: 314-782-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANITA FLAKES
Title or Position: LCSW
Credential:
Phone: 314-782-7216