Healthcare Provider Details

I. General information

NPI: 1427155340
Provider Name (Legal Business Name): JEFFERIES CAUL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N CLAY AVE SUITE 220
SAINT LOUIS MO
63122-4205
US

IV. Provider business mailing address

108 N CLAY AVE SUITE 220
SAINT LOUIS MO
63122-4205
US

V. Phone/Fax

Practice location:
  • Phone: 314-800-5381
  • Fax: 314-894-3836
Mailing address:
  • Phone: 314-800-5381
  • Fax: 314-894-3836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01182
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: