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General NPI Number Information
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NPI Number | 1699121475
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Entity Type | Organization
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Legal Business Name | COMMUNITY AND LONG-TERM CARE PSYCHIATRY LLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD STE 362B
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2178
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Country | US
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Telephone | 314-525-5050
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Fax | 314-525-5072
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Provider Business Mailing Address
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Address Line | 10004 KENNERLY RD STE 362B
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2178
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Country | US
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Telephone | 314-525-5050
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Fax | 314-525-5072
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERNEST ALEXANDER GRAYPEL
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Credential | M.D.
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Telephone | 314-267-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 2015002634
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2015002634
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License Number State | MO
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