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General NPI Number Information
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NPI Number | 1285440891
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Entity Type | Organization
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Legal Business Name | CREVE COEUR PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 11709 OLD BALLAS RD STE 104
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-590-3721
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Fax | 314-866-2530
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Provider Business Mailing Address
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Address Line | 11709 OLD BALLAS RD STE 104
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM SKY
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Credential |
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Telephone | 669-900-0454
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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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