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General NPI Number Information
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NPI Number | 1356795090
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Entity Type | Organization
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Legal Business Name | BJC BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 3309 S KINGSHIGHWAY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1101
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Country | US
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Telephone | 314-206-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 3309 S KINGSHIGHWAY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1101
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Country | US
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Telephone | 314-206-3800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA MARTIN-DAVIS
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Credential |
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Telephone | 314-206-3712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 267-7258
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License Number State | MO
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