Healthcare Provider Details

I. General information

NPI: 1568689727
Provider Name (Legal Business Name): MS. ROSEMARY PATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BIDDLE ST MURPHY O'FALLON HEALTH CLINIC
SAINT LOUIS MO
63106-3454
US

IV. Provider business mailing address

6418 LAKE PADDOCK DR
FLORISSANT MO
63033-4927
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8632
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-775-9202
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number04101
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: