MEDICARE: THE RELATIONSHIP CENTER OF ST. LOUIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	2000165547	MO
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	2000165547	MO

General Provider Information

NPI Number	:	1003146358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RELATIONSHIP CENTER OF ST. LOUIS

Provider Business Mailing Address
First Line	:	7292 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-2438
Country	:	US
Telephone Number	:	314-659-8330
Fax Number	:	314-659-8330

Provider Business Practice Location Address
First Line	:	7292 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-2438
Country	:	US
Telephone Number	:	314-659-8330
Fax Number	:	314-659-8330

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH CLEMSON
Credential	:
Telephone Number	:	314-276-5622

Provider Enumeration Date	:	01/09/2010
Last Update Date	:	01/09/2010

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