Healthcare Provider Details

I. General information

NPI: 1407267537
Provider Name (Legal Business Name): THERESE VERKERKE CASH PHD LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 MURDOCH AVE
SAINT LOUIS MO
63109-2747
US

IV. Provider business mailing address

6201 MURDOCH AVE
SAINT LOUIS MO
63109-2747
US

V. Phone/Fax

Practice location:
  • Phone: 434-953-5370
  • Fax:
Mailing address:
  • Phone: 434-953-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810005553
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2018019557
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: