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MERCY CLINIC CHILD AND ADOLESCENT PSYCHIATRY LLC NPI 1265562300


NPI Information

NPI: 1265562300
Provider Name: MERCY CLINIC CHILD AND ADOLESCENT PSYCHIATRY, LLC
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Organization

Specialization: Child & Adolescent Psychiatry

Address:
615 S NEW BALLAS RD
EDGEWOOD CENTER
SAINT LOUIS, MO
ZIP 63141
Phone: (314) 251-6898
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MERCY CLINIC CHILD AND ADOLESCENT PSYCHIATRY, LLC is a child and adolescent psychiatry psychiatry neurology in Saint Louis, MO. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. MERCY CLINIC CHILD AND ADOLESCENT PSYCHIATRY, LLC NPI is 1265562300. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

615 S NEW BALLAS RD
EDGEWOOD CENTER
SAINT LOUIS, MO
ZIP 63141-221
Phone: (314) 251-6898

The provider's authorized official is John W. Hubert .
The authorized official title is President and has the following contact phone number (314) 251-1700.

The enumeration date for this NPI number is 3/7/2007 and was last updated on 5/8/2014.


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
1101Y00000XCounselorNo
2101YA0400XCounselorAddiction (Substance Use Disorder)No
3101YM0800XCounselorMental HealthNo
4103TA0400XPsychologistAddiction (Substance Use Disorder)No
5103TB0200XPsychologistCognitive & BehavioralNo
6104100000XSocial WorkerNo
72084P0800XPsychiatry & NeurologyPsychiatryNo
82084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryYes

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
1000013410MEDICARE ID-TYPE UNSPECIFIEDMISSOURI

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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