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General NPI Number Information
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NPI Number | 1104569151
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Entity Type | Organization
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Legal Business Name | SERENITY HEALTH LLC
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 11/19/2022
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Provider Practice Location Address
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Address Line | 4905 MEXICO RD STE 400
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City | SAINT PETERS
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State | MO
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Zip | 63376-1601
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Country | US
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Telephone | 314-590-3721
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Fax | 314-214-7380
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Provider Business Mailing Address
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Address Line | 4905 MEXICO RD STE 400
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City | SAINT PETERS
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State | MO
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Zip | 63376-1601
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Country | US
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Telephone | 314-503-6330
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. TARIQ F MALIK
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Credential |
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Telephone | 314-862-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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