Healthcare Provider Details

I. General information

NPI: 1144520008
Provider Name (Legal Business Name): BJC BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S KIRKWOOD RD STE 200
KIRKWOOD MO
63122-6195
US

IV. Provider business mailing address

1 BON PRICE TER
SAINT LOUIS MO
63132-3705
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3912
  • Fax:
Mailing address:
  • Phone: 314-872-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: BALRAM PANTHI
Title or Position: CASE MANAGER
Credential: MSW
Phone: 314-206-3912