Healthcare Provider Details

I. General information

NPI: 1073222683
Provider Name (Legal Business Name): SARAH TYNDALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PROSPECT AVE STE H
KIRKWOOD MO
63122-6024
US

IV. Provider business mailing address

3845 FLAD AVE
SAINT LOUIS MO
63110-4023
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-3753
  • Fax: 833-902-1016
Mailing address:
  • Phone: 314-516-3753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARAH TYNDALL
Title or Position: OWNER
Credential: LCSW
Phone: 314-516-3753