MEDICARE: MULTI-SPECIALTY MENTAL HEALTH SERVICES, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174798938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTI-SPECIALTY MENTAL HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	1224 FERN RIDGE PKWY
Second Line	:	SUITE 305
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-4404
Country	:	US
Telephone Number	:	314-205-8432
Fax Number	:	314-469-4507

Provider Business Practice Location Address
First Line	:	1224 FERN RIDGE PKWY
Second Line	:	SUITE 305
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-4404
Country	:	US
Telephone Number	:	314-205-8432
Fax Number	:	314-469-4507

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAFISA KABIR
Credential	:
Telephone Number	:	314-205-8432

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	02/18/2015

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