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ROTH CLINIC (DBA) NPI 1063764587


NPI Information

NPI: 1063764587
Provider Name: ROTH CLINIC (DBA)
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
734 W PORT PLZ DR.
SUITE 273
SAINT LOUIS, MO
ZIP 63146
Phone: (314) 227-0124
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ROTH CLINIC (DBA) is a community behavioral health in Saint Louis, MO. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. ROTH CLINIC (DBA) NPI is 1063764587. The provider is registered as an organization entity type.

The provider's business location address is:

734 W PORT PLZ DR.
SUITE 273
SAINT LOUIS, MO
ZIP 63146-000
Phone: (314) 227-0124

The provider's authorized official is Lia Angelica Roth .
The authorized official title is President and has the following contact phone number (314) 227-0124.

The enumeration date for this NPI number is 10/8/2012 and was last updated on 10/8/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral Health2009030440MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1MA2277OTHERMISSOURIMEDICARE PTAN
21306164728OTHERMISSOURIMEDICARE NPI TYPE 1
312086529OTHERMISSOURICAQH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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