| Provident Inc. | |
|
2650 Olive St Saint Louis MO 63103-1424 | |
| (314) 371-6500 | |
| (314) 371-1155 |
| Full Name | Provident Inc. |
|---|---|
| Speciality | Counselor |
| Location | 2650 Olive St, Saint Louis, Missouri |
| Authorized Official Name and Position | Kathy S Schlemmer (RELATIONS COORDINATOR) |
| Authorized Official Contact | 3148022647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Inc. 2650 Olive St Saint Louis MO 63103-1424 Ph: (314) 371-6500 | Provident Inc. 2650 Olive St Saint Louis MO 63103-1424 Ph: (314) 371-6500 |
| NPI Number | 1710023791 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 10/05/2022 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 0345217279 |
|---|---|
| Medicare Enrollment ID | O20050407000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710023791 | NPI | - | NPPES |
| MA5670 | Other | MO | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Brooke Hanna Justis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942591169 PECOS PAC ID: 9133349921 Enrollment ID: I20140929002432 |
| Provider Name | Tanja M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447654827 PECOS PAC ID: 1254653652 Enrollment ID: I20141212001157 |
| Provider Name | Stacy L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174002232 PECOS PAC ID: 5991057671 Enrollment ID: I20181008001380 |
| Provider Name | Elizabeth Ann Reinberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669759783 PECOS PAC ID: 3779828660 Enrollment ID: I20181220003400 |
| Provider Name | Jennifer J. Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194221200 PECOS PAC ID: 5890033591 Enrollment ID: I20190205000280 |
| Provider Name | Sarah Elizabeth Cirese-payton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053876292 PECOS PAC ID: 5698014629 Enrollment ID: I20190308000667 |
| Provider Name | Courtney Paige Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639796766 PECOS PAC ID: 0143647479 Enrollment ID: I20200901000504 |
| Provider Name | Alexander Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881289510 PECOS PAC ID: 9931516549 Enrollment ID: I20210326001953 |
| Provider Name | Victoria N Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568945020 PECOS PAC ID: 0042686800 Enrollment ID: I20221019000936 |
| Provider Name | Dayton J Nelsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417670654 PECOS PAC ID: 1254700578 Enrollment ID: I20221208002039 |
| Provider Name | Kelley Cassens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942993894 PECOS PAC ID: 6901267111 Enrollment ID: I20230804000543 |
| Provider Name | Melissa Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174246441 PECOS PAC ID: 1658729124 Enrollment ID: I20231121002922 |
| Provider Name | Karolyn Marie Ratliff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508596461 PECOS PAC ID: 4082061510 Enrollment ID: I20231121003058 |
| Provider Name | Sarah E Paradise |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427594548 PECOS PAC ID: 5799133096 Enrollment ID: I20231128000379 |
| Provider Name | Jaskirat Kaur |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518587849 PECOS PAC ID: 6709234024 Enrollment ID: I20231128001246 |
| Provider Name | Cynthia A Jung |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073145900 PECOS PAC ID: 0547618878 Enrollment ID: I20231128001552 |
| Provider Name | Samantha Jane Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124613005 PECOS PAC ID: 0042668386 Enrollment ID: I20231128001765 |
| Provider Name | Gabriella Santos Francisco |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386262541 PECOS PAC ID: 6800244393 Enrollment ID: I20231128002040 |
| Provider Name | Karen B Gabriel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689070153 PECOS PAC ID: 8224486469 Enrollment ID: I20231128002155 |
| Provider Name | Tracie Marie Striebel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467040949 PECOS PAC ID: 6406204643 Enrollment ID: I20231128002187 |
| Provider Name | Daniel Michael Dwyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023698982 PECOS PAC ID: 2567810039 Enrollment ID: I20231130000739 |
| Provider Name | Rachel J Welch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255088779 PECOS PAC ID: 0941652150 Enrollment ID: I20240123002883 |
| Provider Name | Angela Wallace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417435819 PECOS PAC ID: 1850735150 Enrollment ID: I20240214002965 |
| Provider Name | Brenda Alexia Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619535986 PECOS PAC ID: 5991139388 Enrollment ID: I20240424003235 |
| Provider Name | Alexandrea Michelle Ward |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699494781 PECOS PAC ID: 9032652847 Enrollment ID: I20240621001142 |
| Provider Name | Carol A Long |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346450616 PECOS PAC ID: 1759824576 Enrollment ID: I20240621001521 |
| Provider Name | Emory Madalyn Endicott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376276774 PECOS PAC ID: 5496286767 Enrollment ID: I20240927001949 |
| Provider Name | Jillian O'brien |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083276919 PECOS PAC ID: 7719419894 Enrollment ID: I20241014003721 |
| Provider Name | Emily R Maier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598477036 PECOS PAC ID: 5698207165 Enrollment ID: I20241022003127 |
| Provider Name | Grace M Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932818838 PECOS PAC ID: 4486183449 Enrollment ID: I20250121003244 |
| Provider Name | Joanna Sigmund |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1962216424 PECOS PAC ID: 5092237040 Enrollment ID: I20250319001092 |
| Provider Name | Rashida A Bantu-foster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497236822 PECOS PAC ID: 2264955657 Enrollment ID: I20250326002034 |
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