MEDICARE: TYREE EDWARD MILLER BEHAVIORAL HEALTH SERVICES

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

General Provider Information

NPI Number	:	1568990505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYREE EDWARD MILLER BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2829 GAINSBORO CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4717
Country	:	US
Telephone Number	:	314-853-9839
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 GAINSBORO CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4717
Country	:	US
Telephone Number	:	314-853-9839
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER/CEO
Name	:	MR. TYREE EDWARD MILLER
Credential	:	LCSW
Telephone Number	:	314-853-9839

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	07/21/2022

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