Healthcare Provider Details

I. General information

NPI: 1588094312
Provider Name (Legal Business Name): COMMUNITY BEHAVIOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: COMMUNITY BEHAVIOR HEALTH

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S. VANDEVENTER AVE
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

1027 S. VANDEVENTER AVE
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-3423
  • Fax:
Mailing address:
  • Phone: 314-8333423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder)
License Number=========
License Number StateMO
# 2
Primary Taxonomy
Taxonomy Code
Taxonomy193200000X
License Number
License Number State
# 3
Primary Taxonomy
Taxonomy Code
Taxonomy101YA0400X
License Number
License Number State

VIII. Authorized Official

Name: MR. NAIM MUHAMMAD
Title or Position: DIRECTOR
Credential:
Phone: 314-556-4443