Healthcare Provider Details

I. General information

NPI: 1215245428
Provider Name (Legal Business Name): MONIQUE ADRIANNE MAXEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ARSENAL ST
SAINT LOUIS MO
63139-1463
US

IV. Provider business mailing address

5300 ARSENAL ST
SAINT LOUIS MO
63139-1463
US

V. Phone/Fax

Practice location:
  • Phone: 314-877-0624
  • Fax:
Mailing address:
  • Phone: 314-877-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2022044875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: