MEDICARE: DR. CAROLYN ASHLEY MYLES VERSICAL PSY.D.

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	103TC0700X	Clinical Psychologist	071009714	IL
2	103TC0700X	Clinical Psychologist	2019018304	MO

General Provider Information

NPI Number	:	1144774647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN ASHLEY MYLES VERSICAL PSY.D.

Provider Business Mailing Address
First Line	:	7710 CARONDELET AVE STE 304
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-391-8030
Fax Number	:	833-969-0194

Provider Business Practice Location Address
First Line	:	7710 CARONDELET AVE STE 304
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	143-918-0303
Fax Number	:	833-969-0194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	09/03/2024

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