Healthcare Provider Details

I. General information

NPI: 1588255806
Provider Name (Legal Business Name): PATRICK CHARLIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 FOREST PARK AVE
SAINT LOUIS MO
63108-2810
US

IV. Provider business mailing address

4245 FOREST PARK AVE
SAINT LOUIS MO
63108-2810
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-4545
  • Fax: 314-286-4542
Mailing address:
  • Phone: 314-286-4545
  • Fax: 314-286-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022034557
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: