Healthcare Provider Details

I. General information

NPI: 1306020797
Provider Name (Legal Business Name): COMMUNITY BEHAVIOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S VANDEVENTER AVE FL 2
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

4500 WASHINGTON
ST LOUIS MO
63108
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-0804
  • Fax:
Mailing address:
  • Phone: 314-367-0302
  • Fax: 314-367-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. NAIM MUHAMMAD
Title or Position: DIRECTOR
Credential: M.ED, BA, RASAC
Phone: 314-556-4443