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General NPI Number Information
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NPI Number | 1740714823
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Entity Type | Organization
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Legal Business Name | STORGE LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 7114 VERNON AVE
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-2301
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Country | US
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Telephone | 314-475-4147
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Fax | 314-216-3710
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Provider Business Mailing Address
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Address Line | PO BOX 142860
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City | SAINT LOUIS
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State | MO
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Zip | 63114-0860
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Country | US
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Telephone | 314-475-4147
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Fax | 314-282-0688
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Authorized Official
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Title or Position | CEO
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Name | DEJA RENEE SCOTT
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Credential |
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Telephone | 314-449-9420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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