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General NPI Number Information
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NPI Number | 1972791531
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Entity Type | Organization
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Legal Business Name | ST. LOUIS BEHAVIORAL ASSOCIATES LTD.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 05/03/2010
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Provider Practice Location Address
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Address Line | 745 CRAIG RD SUITE 210
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7160
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Country | US
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Telephone | 314-997-1183
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Fax | 314-997-1196
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Provider Business Mailing Address
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Address Line | 745 CRAIG RD SUITE 210
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7160
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Country | US
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Telephone | 314-997-1183
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Fax | 314-997-1196
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. STEPHANIE ANNE MOERGEN
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Credential | PH.D.
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Telephone | 314-997-1183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 01628
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License Number State | MO
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