MEDICARE: RIGHTEOUS TREES 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	251S00000X	Community/Behavioral Health Agency	2004004692	MO

General Provider Information

NPI Number	:	1548438732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIGHTEOUS TREES LLC

Provider Business Mailing Address
First Line	:	11438 PINEVIEW CROSSING DRIVE
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-5104
Country	:	US
Telephone Number	:	314-650-6421
Fax Number	:	314-738-0153

Provider Business Practice Location Address
First Line	:	11438 PINEVIEW CROSSING DRIVE
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-5104
Country	:	US
Telephone Number	:	314-650-6421
Fax Number	:	314-738-0153

Authorized Official
Title or Position	:	FAMILY THERAPIST
Name	:	MRS. JOCELYN RENEE FANE
Credential	:	LCSW
Telephone Number	:	314-650-6421

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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