Healthcare Provider Details

I. General information

NPI: 1609204734
Provider Name (Legal Business Name): STEVEN A. HARVEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11477 OLDE CABIN RD SUITE 210
SAINT LOUIS MO
63141-7130
US

IV. Provider business mailing address

11477 OLDE CABIN RD SUITE 210
SAINT LOUIS MO
63141-7130
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-5208
  • Fax:
Mailing address:
  • Phone: 314-997-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number101008
License Number StateMO

VIII. Authorized Official

Name: DR. STEVEN HARVEY
Title or Position: OWNER
Credential: MD
Phone: 314-997-5208