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General NPI Number Information
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NPI Number | 1780546887
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH LIFE LLC
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 4087 N SAINT PETERS PKWY
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City | SAINT PETERS
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State | MO
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Zip | 63304-7396
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Country | US
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Telephone | 636-775-4894
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Fax | 855-719-2526
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Provider Business Mailing Address
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Address Line | 206 CANDICE WAY
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City | SAINT PETERS
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State | MO
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Zip | 63376-4621
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Country | US
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Telephone | 636-775-4894
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Fax | 855-719-2526
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ALEXANDER SHAW
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Credential |
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Telephone | 636-279-0847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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