Healthcare Provider Details

I. General information

NPI: 1104028950
Provider Name (Legal Business Name): EDUCATIONAL & PSYCHOLOGICAL SVCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BELLEVUE AVE
SAINT LOUIS MO
63117-1701
US

IV. Provider business mailing address

44 GOUVENOR LN
SAINT LOUIS MO
63124-1309
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-4488
  • Fax: 314-647-6305
Mailing address:
  • Phone: 314-647-4488
  • Fax: 314-647-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002023730
License Number StateMO

VIII. Authorized Official

Name: JAY RUSSELL HYKEN
Title or Position: PRESIDENT PRIMARY MEMBER
Credential: LPC
Phone: 314-647-4488