MEDICARE: ST. CHARLES PSYCHIATRIC ASSOCIATES, INC.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1164631495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CHARLES PSYCHIATRIC ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	4801 WELDON SPRING PKWY STE 300
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-9101
Country	:	US
Telephone Number	:	636-949-5760
Fax Number	:	866-440-9231

Provider Business Practice Location Address
First Line	:	4801 WELDON SPRING PKWY STE 300
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-9101
Country	:	US
Telephone Number	:	636-949-5760
Fax Number	:	866-440-9231

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JASMINE M TIDWELL
Credential	:
Telephone Number	:	636-949-5760

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/08/2025

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