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General NPI Number Information
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NPI Number | 1851618284
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Entity Type | Organization
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Legal Business Name | NEUROREGENESIS, P.C.
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Dates
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Enumeration Date | 04/25/2010
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1176 TOWN AND COUNTRY COMMONS
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City | CHESTERFIELD
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State | MO
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Zip | 63017-8200
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Country | US
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Telephone | 636-893-1137
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Fax | 636-893-1101
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Provider Business Mailing Address
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Address Line | 1176 TOWN AND COUNTRY COMMONS
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City | CHESTERFIELD
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State | MO
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Zip | 63017-8200
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Country | US
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Telephone | 610-996-1200
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Fax | 636-893-1101
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ROBERT ANDREW GILLESPIE
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Credential | PH.D.
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Telephone | 610-996-1200
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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 | 2007006356
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License Number State | MO
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