| Mercy Clinic Child And Adolescent Psychiatry, Llc | |
|
615 S New Ballas Rd Edgewood Center Saint Louis MO 63141-8221 | |
| (314) 251-6898 | |
| Not Available |
| Full Name | Mercy Clinic Child And Adolescent Psychiatry, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 615 S New Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | John W. Hubert (PRESIDENT) |
| Authorized Official Contact | 3142511700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Clinic Child And Adolescent Psychiatry, Llc 615 S New Ballas Rd Saint Louis MO 63141-8221 Ph: (314) 251-6898 | Mercy Clinic Child And Adolescent Psychiatry, Llc 615 S New Ballas Rd Edgewood Center Saint Louis MO 63141-8221 Ph: (314) 251-6898 |
| NPI Number | 1265562300 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 05/08/2014 |
| Medicare PECOS PAC ID | 7113981721 |
|---|---|
| Medicare Enrollment ID | O20041115000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265562300 | NPI | - | NPPES |
| Provider Name | Karen A Jacobi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497816284 PECOS PAC ID: 2567359417 Enrollment ID: I20040303001324 |
| Provider Name | Scott A Trail |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437110798 PECOS PAC ID: 3173673605 Enrollment ID: I20090604000146 |
| Provider Name | Michael R Banton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619984523 PECOS PAC ID: 4981796588 Enrollment ID: I20100824000118 |
| Provider Name | Lelia K Lindhorst |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962470021 PECOS PAC ID: 4587848189 Enrollment ID: I20110406000169 |
| Provider Name | Kristina Radoulova |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720287089 PECOS PAC ID: 5092984856 Enrollment ID: I20110811000562 |
| Provider Name | David N Mcvey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134210024 PECOS PAC ID: 3375701279 Enrollment ID: I20120223000514 |
| Provider Name | Kelley E Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942540745 PECOS PAC ID: 4082852249 Enrollment ID: I20130529000500 |
| Provider Name | Gina M Bufe |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1326381765 PECOS PAC ID: 7517108384 Enrollment ID: I20130722000346 |
| Provider Name | Thomas Horn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841516598 PECOS PAC ID: 2264695501 Enrollment ID: I20140722002256 |
| Provider Name | Yuval Asner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407099658 PECOS PAC ID: 2466601497 Enrollment ID: I20150730012980 |
| Provider Name | Pearl Serota |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689881567 PECOS PAC ID: 3870809841 Enrollment ID: I20150908000116 |
| Provider Name | Kelechi J N Loynd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720104888 PECOS PAC ID: 9335308246 Enrollment ID: I20160309000296 |
| Provider Name | Pravesh Prabhu Deotale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710275110 PECOS PAC ID: 2163660283 Enrollment ID: I20160708000233 |
| Provider Name | Enos Moss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548527997 PECOS PAC ID: 1153692876 Enrollment ID: I20170728003070 |
| Provider Name | Shelah Radke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366695967 PECOS PAC ID: 8426386319 Enrollment ID: I20190830001285 |
| Provider Name | Danielle Mcelroy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700545498 PECOS PAC ID: 6800287293 Enrollment ID: I20211218000110 |
| Provider Name | Carrie Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467757013 PECOS PAC ID: 2365836715 Enrollment ID: I20220228002284 |
| Provider Name | Anson Varghese |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558895441 PECOS PAC ID: 9234416868 Enrollment ID: I20220812002369 |
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