Healthcare Provider Details

I. General information

NPI: 1831274943
Provider Name (Legal Business Name): SPARROW PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CRAIG RD SUITE 100
SAINT LOUIS MO
63141-7138
US

IV. Provider business mailing address

777 CRAIG RD SUITE 100
SAINT LOUIS MO
63141-7138
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-1033
  • Fax: 314-395-2432
Mailing address:
  • Phone: 314-991-1033
  • Fax: 314-395-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLC0731335
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLC0731335
License Number StateMO

VIII. Authorized Official

Name: DR. ROBIN SUSAN PARK
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 314-991-1033