=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588094312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY BEHAVIOR HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2013
-----------------------------------------------------
Last Update Date | 07/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1027 S. VANDEVENTER AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-833-3423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1027 S. VANDEVENTER AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-8333423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. NAIM MUHAMMAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-556-4443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder)
-----------------------------------------------------
License Number | =========
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code |
-----------------------------------------------------
Taxonomy Name | 193200000X
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code |
-----------------------------------------------------
Taxonomy Name | 101YA0400X
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------