Healthcare Provider Details

I. General information

NPI: 1770416885
Provider Name (Legal Business Name): MISSOURI MENTAL HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S CLAY AVE APT 3A
SAINT LOUIS MO
63122-5964
US

IV. Provider business mailing address

550 S CLAY AVE APT 3A
SAINT LOUIS MO
63122-5964
US

V. Phone/Fax

Practice location:
  • Phone: 314-702-0603
  • Fax:
Mailing address:
  • Phone: 314-702-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT JOSEPH GRAYSON JR.
Title or Position: PRESIDENT
Credential:
Phone: 314-702-0603