Healthcare Provider Details

I. General information

NPI: 1487732335
Provider Name (Legal Business Name): ST. LOUIS BEHAVIORAL MEDICINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 MACKLIND AVE
SAINT LOUIS MO
63110-1440
US

IV. Provider business mailing address

1129 MACKLIND AVE
SAINT LOUIS MO
63110-1440
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-0200
  • Fax:
Mailing address:
  • Phone: 314-534-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2006006594
License Number StateMO

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300