Healthcare Provider Details

I. General information

NPI: 1265956544
Provider Name (Legal Business Name): FAMILY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 OLD OLIVE STREET RD
SAINT LOUIS MO
63141-5914
US

IV. Provider business mailing address

10420 OLD OLIVE STREET RD
SAINT LOUIS MO
63141-5914
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-6688
  • Fax: 314-991-6690
Mailing address:
  • Phone: 314-991-6688
  • Fax: 314-991-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2016032249
License Number StateMO

VIII. Authorized Official

Name: DR. OKSANA BARAM
Title or Position: PRESIDENT
Credential: MD
Phone: 314-991-6688