Healthcare Provider Details

I. General information

NPI: 1215874672
Provider Name (Legal Business Name): PREMIERPATH BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 HAMLET CT
LAKE ST LOUIS MO
63367-5006
US

IV. Provider business mailing address

417 HAMLET CT
LAKE ST LOUIS MO
63367-5006
US

V. Phone/Fax

Practice location:
  • Phone: 314-262-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHIKA IJIOMA
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 314-262-1820