Healthcare Provider Details

I. General information

NPI: 1700055480
Provider Name (Legal Business Name): CHERYL GRIFFIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 LADUE RD THIRD FLOOR, STE. 317
SAINT LOUIS MO
63124-2079
US

IV. Provider business mailing address

8820 LADUE RD THIRD FLOOR, STE. 317
SAINT LOUIS MO
63124-2079
US

V. Phone/Fax

Practice location:
  • Phone: 314-754-3258
  • Fax:
Mailing address:
  • Phone: 314-754-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberSW004527
License Number StateMO

VIII. Authorized Official

Name: CHERYL GRIFFIN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 314-754-3258