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General NPI Number Information
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NPI Number | 1346630852
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Entity Type | Organization
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Legal Business Name | STATE OF MISSOURI DEPARTMENT OF MENTAL HEALTH
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 5300 ARSENAL ST
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1463
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Country | US
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Telephone | 314-877-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 ARSENAL ST
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1463
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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 | DIRECTOR OF ADMINISTRATIVE SERVICES
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Name | MOLLY JANE BOECKMANN
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Credential |
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Telephone | 573-751-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 2013040167
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License Number State | MO
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