State of Missouri
NPI #1376753798 in Saint Louis, Missouri
Provider Information
- NPI Number
- 1376753798
- Entity Type
- Organization
- Organization Name
- State of Missouri
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- STATE OF MISSOURI
- Primary Specialty
- Psychiatry & Neurology - Psychiatry
- Enumeration Date
- May 23, 2007
- Last Updated
- Oct 27, 2020
Practice Location
- Address
- 1901 PENNSYLVANIA AVE
- City
- Saint Louis
- State
- Missouri
- ZIP Code
- 63133-1325
- Phone
- (314) 512-7800
Authorized Official
- Name
- MOLLY JANE BOECKMANN
- Title
- DIRECTOR OF ADMINISTRATIVE SERVICES
- Phone
- (573) 751-4055
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist |
| Social Worker - Clinical — Clinical |
| Psychiatry & Neurology - Psychiatry — Psychiatry |
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