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General NPI Number Information
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NPI Number | 1104028950
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Entity Type | Organization
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Legal Business Name | EDUCATIONAL & PSYCHOLOGICAL SVCS LLC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 BELLEVUE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1701
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Country | US
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Telephone | 314-647-4488
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Fax | 314-647-6305
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Provider Business Mailing Address
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Address Line | 44 GOUVENOR LN
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1309
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Country | US
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Telephone | 314-647-4488
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Fax | 314-647-6305
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Authorized Official
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Title or Position | PRESIDENT PRIMARY MEMBER
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Name | JAY RUSSELL HYKEN
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Credential | LPC
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Telephone | 314-647-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2002023730
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License Number State | MO
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