MEDICARE: TI TMS AND BEHAVIORAL HEALTH LLC

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	106S00000X	Behavior Technician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1013634328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TI TMS AND BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1505 S BIG BEND BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2205
Country	:	US
Telephone Number	:	314-384-1006
Fax Number	:	314-384-1007

Provider Business Practice Location Address
First Line	:	1505 S BIG BEND BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2205
Country	:	US
Telephone Number	:	314-599-7718
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY CAROLE INMAN
Credential	:
Telephone Number	:	314-599-7718

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	12/14/2022

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