Healthcare Provider Details

I. General information

NPI: 1114252004
Provider Name (Legal Business Name): BJC BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S KIRKWOOD RD STE 2
SAINT LOUIS MO
63122-6195
US

IV. Provider business mailing address

343 S KIRKWOOD RD STE 2
SAINT LOUIS MO
63122-6195
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3400
  • Fax:
Mailing address:
  • Phone: 314-206-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2009007494
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2009007494
License Number StateMO

VIII. Authorized Official

Name: MISS REBECCA LEA DAVIS
Title or Position: CLINICAL CASE MANAGER
Credential: MSW, LCSW
Phone: 314-206-3494