| Foundations For Change, Llc | |
|
3115 S Grand Blvd St. Louis MO 63118 | |
| (314) 577-0444 | |
| Not Available |
| Full Name | Foundations For Change, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3115 S Grand Blvd, St. Louis, Missouri |
| Authorized Official Name and Position | Alexandria C. Boyer (PARTNER) |
| Authorized Official Contact | 3145770444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundations For Change, Llc 3115 S Grand Blvd St. Louis MO 63118 Ph: (314) 577-0444 | Foundations For Change, Llc 3115 S Grand Blvd St. Louis MO 63118 Ph: (314) 577-0444 |
| NPI Number | 1952650442 |
|---|---|
| Provider Enumeration Date | 08/30/2012 |
| Last Update Date | 08/30/2012 |
| Medicare PECOS PAC ID | 3971868050 |
|---|---|
| Medicare Enrollment ID | O20180518001213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952650442 | NPI | - | NPPES |
| 133624356 | Medicaid | MO | |
| 1861703944 | Medicaid | MO | |
| 1144578519 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Marta H Da Silva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831176353 PECOS PAC ID: 4082681820 Enrollment ID: I20040913000403 |
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