Healthcare Provider Details

I. General information

NPI: 1558518639
Provider Name (Legal Business Name): URBAN BEHAVIORAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 S JEFFERSON AVE
SAINT LOUIS MO
63104-1902
US

IV. Provider business mailing address

1104 S JEFFERSON AVE
SAINT LOUIS MO
63104-1902
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5000
  • Fax: 314-577-5003
Mailing address:
  • Phone: 314-577-5000
  • Fax: 314-577-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number01830
License Number StateMO

VIII. Authorized Official

Name: DR. LINDA SHARPE-TAYLO
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 314-577-5000