Healthcare Provider Details

I. General information

NPI: 1447537071
Provider Name (Legal Business Name): PSYCHIATRIC CARE AND RESEARCH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 KEATON CROSSING BLVD STE 201
O FALLON MO
63368-8222
US

IV. Provider business mailing address

4132 KEATON CROSSING BLVD STE 201
O FALLON MO
63368-8222
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-3589
  • Fax: 636-244-3594
Mailing address:
  • Phone: 636-244-3589
  • Fax: 636-244-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P CANALE
Title or Position: PRESIDENT
Credential: MD
Phone: 636-244-3589