MEDICARE: CHILDREN'S FOUNDATION OF MID AMERICA

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	003385	MO

General Provider Information

NPI Number	:	1801109343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S FOUNDATION OF MID AMERICA

Provider Business Mailing Address
First Line	:	3420 NEBRASKA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2921
Country	:	US
Telephone Number	:	314-920-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 N WARSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1807
Country	:	US
Telephone Number	:	314-989-9727
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. JUDY KAYE TONER COHN
Credential	:	LCSW
Telephone Number	:	314-989-9727

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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Directions to “CHILDREN'S FOUNDATION OF MID AMERICA ” Practice Location

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