Healthcare Provider Details

I. General information

NPI: 1487718854
Provider Name (Legal Business Name): CATHOLIC COMPREHENSIVE SERVICES FOR CHILDREN, CHILD CENTER-MARYGROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 MULLANPHY LN
FLORISSANT MO
63031-3727
US

IV. Provider business mailing address

2705 MULLANPHY LN
FLORISSANT MO
63031-3727
US

V. Phone/Fax

Practice location:
  • Phone: 314-837-1702
  • Fax: 314-830-6263
Mailing address:
  • Phone: 314-837-1702
  • Fax: 314-830-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number000045669
License Number StateMO

VIII. Authorized Official

Name: DR. MICHAEL P MEEHAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D.
Phone: 314-830-6222