=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730698895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA ALLIED MENTAL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2017
-----------------------------------------------------
Last Update Date | 02/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 WALL ST STE 110
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63303-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-493-9008
-----------------------------------------------------
Fax | 888-534-9208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1585 WOODLAKE DR STE 110
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-534-8913
-----------------------------------------------------
Fax | 888-534-9208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP
-----------------------------------------------------
Name | QUENTIN CHAMBERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-493-9008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 2014017973
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------