=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558518639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URBAN BEHAVIORAL HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2008
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1104 S JEFFERSON AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63104-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-577-5000
-----------------------------------------------------
Fax | 314-577-5003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1104 S JEFFERSON AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63104-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-577-5000
-----------------------------------------------------
Fax | 314-577-5003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. LINDA SHARPE-TAYLO
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 314-577-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 01830
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------