1194140756 NPI number — EMERGENCE PSYCHOLOGICAL SERVICES

Table of content: (NPI 1194140756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194140756 NPI number — EMERGENCE PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
EMERGENCE PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1194140756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1131 THORNWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63124-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-800-4215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1131 THORNWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63124-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-800-4215
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FALCONER
Authorized Official First Name:
JAMECA
Authorized Official Middle Name:
Authorized Official Title or Position:
COUNSELING PSYCHOLOGIST
Authorized Official Telephone Number:
314-800-4215

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  LC1378481 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)