St. Louis Behavioral Medicine Institute Inc | |
331 Salem Place Ste 225a Fairview Executive Plaza Ii Fairview Heights IL 62208 | |
(618) 825-0051 | |
Not Available |
Full Name | St. Louis Behavioral Medicine Institute Inc |
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Speciality | Counselor |
Location | 331 Salem Place Ste 225a, Fairview Heights, Illinois |
Authorized Official Name and Position | Steve Filton (VICE PRESIDENT) |
Authorized Official Contact | 6107683300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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St. Louis Behavioral Medicine Institute Inc 1129 Macklind Ave Saint Louis MO 63110-1440 Ph: (314) 881-3446 | St. Louis Behavioral Medicine Institute Inc 331 Salem Place Ste 225a Fairview Executive Plaza Ii Fairview Heights IL 62208 Ph: (618) 825-0051 |
NPI Number | 1952169179 |
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Provider Enumeration Date | 03/12/2024 |
Last Update Date | 03/12/2024 |
Certification Date | 03/12/2024 |
Medicare PECOS PAC ID | 3173428638 |
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Medicare Enrollment ID | O20240510000309 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952169179 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Kathy J Corn |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1689769119 PECOS PAC ID: 4880035666 Enrollment ID: I20240510000734 |
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