Healthcare Provider Details

I. General information

NPI: 1801122171
Provider Name (Legal Business Name): CHRISTINE CURTIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
ST LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5667
  • Fax: 314-268-2784
Mailing address:
  • Phone: 314-577-5667
  • Fax: 314-268-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2008030677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: