Healthcare Provider Details

I. General information

NPI: 1699892885
Provider Name (Legal Business Name): MICHAEL ARTHUR MCLEOD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 ROLFE DR
SAINT LOUIS MO
63122-1648
US

IV. Provider business mailing address

724 ROLFE DR
SAINT LOUIS MO
63122-1648
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-3318
  • Fax:
Mailing address:
  • Phone: 314-965-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number01216
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: