Healthcare Provider Details

I. General information

NPI: 1093430944
Provider Name (Legal Business Name): DEPRESSION CLINIC AT THE HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 RAYMOND DR
SAINT CHARLES MO
63301-4872
US

IV. Provider business mailing address

2621 RAYMOND DR
SAINT CHARLES MO
63301-4872
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-2244
  • Fax: 636-946-6975
Mailing address:
  • Phone: 636-946-2244
  • Fax: 636-946-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS KAYLA C BROOKS
Title or Position: DIRECTOR
Credential: M.A, EMT-B, CTMS
Phone: 636-946-2244