1437337029 NPI number — CREATIVE PATHWAYS TO WHOLENESS, LLC

Table of content: (NPI 1437337029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437337029 NPI number — CREATIVE PATHWAYS TO WHOLENESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE PATHWAYS TO WHOLENESS, LLC
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:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437337029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7750 CLAYTON RD
Provider Second Line Business Mailing Address:
SUITE 308 A
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-644-4422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7750 CLAYTON RD
Provider Second Line Business Practice Location Address:
SUITE 308 A
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-644-4422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ST. CLAIR
Authorized Official First Name:
MARY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
314-644-4422

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW00003838 , 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)

  • Identifier: 490614104 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209651 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com