| Phoenix Psychological Group, Inc | |
|
225 S Meramec Ave Suite 506 Saint Louis MO 63105-3596 | |
| (314) 863-3588 | |
| (314) 863-0074 |
| Full Name | Phoenix Psychological Group, Inc |
|---|---|
| Speciality | Psychologist |
| Location | 225 S Meramec Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Patricia S Shaw (PRESIDENT) |
| Authorized Official Contact | 3148633588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Psychological Group, Inc 225 S Meramec Ave Suite 506 Saint Louis MO 63105-3596 Ph: (314) 863-3588 | Phoenix Psychological Group, Inc 225 S Meramec Ave Suite 506 Saint Louis MO 63105-3596 Ph: (314) 863-3588 |
| NPI Number | 1386767994 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9931397163 |
|---|---|
| Medicare Enrollment ID | O20110103000587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386767994 | NPI | - | NPPES |
| 493257802 | Medicaid | MO | |
| 1245254317 | Other | MO | NPI-PATRICIA SHAW |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | PY01201 (Missouri) | Primary |
| Provider Name | Patricia S Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245254317 PECOS PAC ID: 1658569892 Enrollment ID: I20110103000617 |
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