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General NPI Number Information
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NPI Number | 1306142278
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Entity Type | Organization
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Legal Business Name | D. EARLY, PH.D., INC.
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 6220 S LINDBERGH BLVD SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63123-7839
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Country | US
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Telephone | 314-894-2900
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Fax | 314-894-2960
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Provider Business Mailing Address
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Address Line | 6220 S LINDBERGH BLVD SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63123-7839
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Country | US
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Telephone | 314-894-2900
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Fax | 314-894-2960
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Authorized Official
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Title or Position | PRESIDENT, LICENSED PSYCHOLOGIST
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Name | DR. DEBRA J EARLY
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Credential | PH.D.
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Telephone | 314-894-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2006028096
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License Number State | MO
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