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General NPI Number Information
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NPI Number | 1841743317
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES OF ST. LOUIS, LLC
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 08/01/2016
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Provider Practice Location Address
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Address Line | 7110 OAKLAND AVE SUITE 105
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1868
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Country | US
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Telephone | 314-884-0779
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Fax | 314-227-9327
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Provider Business Mailing Address
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Address Line | 7110 OAKLAND AVE SUITE 105
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1868
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Country | US
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Telephone | 314-884-0779
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Fax | 314-227-9327
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. GREGORY A GOLDMAN
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Credential | PH.D.
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Telephone | 314-884-8075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2010030791
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License Number State | MO
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