Healthcare Provider Details

I. General information

NPI: 1801807847
Provider Name (Legal Business Name): BJC BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 MAPLE ST
FARMINGTON MO
63640-1955
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-5353
  • Fax:
Mailing address:
  • Phone: 314-206-3700
  • Fax: 314-206-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number267-7258
License Number StateMO

VIII. Authorized Official

Name: ANGELA MARTIN-DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 314-206-3712