Healthcare Provider Details

I. General information

NPI: 1942113246
Provider Name (Legal Business Name): THERATEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PERSHALL RD FL 3
SAINT LOUIS MO
63136-4442
US

IV. Provider business mailing address

10554 MT EMERALD DR
PEYTON CO
80831-8203
US

V. Phone/Fax

Practice location:
  • Phone: 557-256-7408
  • Fax:
Mailing address:
  • Phone: 719-491-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM TERRY GRIER
Title or Position: CEO
Credential:
Phone: 719-491-5223