Healthcare Provider Details

I. General information

NPI: 1285877134
Provider Name (Legal Business Name): CURATORS OF THE UNIVERSITY OF MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY BLVD DEPT. OF PSYCHOLOGY, UNIVERSITY OF MISSOURI-ST. LOUIS
SAINT LOUIS MO
63121-4400
US

IV. Provider business mailing address

1 UNIVERSITY BLVD DEPT. OF PSYCHOLOGY, UNIVERSITY OF MISSOURI-ST. LOUIS
SAINT LOUIS MO
63121-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5824
  • Fax: 314-516-5347
Mailing address:
  • Phone: 314-516-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA VINOCOUR
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 314-516-5824