Healthcare Provider Details

I. General information

NPI: 1629476957
Provider Name (Legal Business Name): CENTERPOINTE OUTPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-7300
  • Fax:
Mailing address:
  • Phone: 636-441-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MOHD AZFAR MALIK
Title or Position: CEO
Credential: MD, MBA
Phone: 636-441-7300