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General NPI Number Information
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NPI Number | 1538609060
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Entity Type | Organization
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Legal Business Name | SIDS RESOURCES INC
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1120 S 6TH ST SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63104-3602
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Country | US
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Telephone | 314-241-7437
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 S 6TH ST SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63104-3602
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Country | US
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Telephone | 314-241-7437
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LORI J BEHRENS
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Credential |
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Telephone | 314-241-7437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005209
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License Number State | MO
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