MEDICARE: HAWK BEHAVIORAL HEALTH 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	2002027247	MO

General Provider Information

NPI Number	:	1760659445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWK BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	9191 W FLORISSANT AVE
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1424
Country	:	US
Telephone Number	:	314-882-6840
Fax Number	:	618-566-8186

Provider Business Practice Location Address
First Line	:	9191 W FLORISSANT AVE
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1424
Country	:	US
Telephone Number	:	314-882-6840
Fax Number	:	618-566-8186

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HUEY LEE HAWKINS JR.
Credential	:	L.C.S.W
Telephone Number	:	314-882-6840

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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