Healthcare Provider Details

I. General information

NPI: 1912250721
Provider Name (Legal Business Name): MERCY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DES PERES RD SUITE 200-C
SAINT LOUIS MO
63131-2050
US

IV. Provider business mailing address

1000 DES PERES RD SUITE 200-C
SAINT LOUIS MO
63131-2050
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE C. HARRISON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-729-4667