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General NPI Number Information
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NPI Number | 1376674242
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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 | 03/09/2007
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 1085 MAPLE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1955
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Country | US
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Telephone | 573-756-5353
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Fax | 573-756-4557
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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 | 314-206-3700
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Fax | 314-206-3881
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARK STANSBERRY
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Credential |
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Telephone | 314-206-3714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 267-7258
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License Number State | MO
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