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NPI Code Detail

MEDICARE: SOJOURN THERAPY OUTREACH LLC

MEDICARE: SOJOURN THERAPY OUTREACH 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1679121529
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOJOURN THERAPY OUTREACH LLC
Provider Business Mailing Address
First Line : 9666 OLIVE BLVD STE 330
Second Line :
City : OLIVETTE
State : MO
Zip : 63132-3035
Country : US
Telephone Number : 314-399-4823
Fax Number :
Provider Business Practice Location Address
First Line : 9666 OLIVE BLVD STE 330
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-3035
Country : US
Telephone Number : 314-399-4823
Fax Number :
Authorized Official
Title or Position : THERAPIST/OWNE
Name : MS. SHELLY L BYNDOM
Credential : LCSW
Telephone Number : 314-399-4823
Provider Enumeration Date : 09/03/2019
Last Update Date : 09/23/2019

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Directions to “SOJOURN THERAPY OUTREACH LLC ” Practice Location

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