| The Center For Mindfulness And Cbt, Llc | |
|
10845 Olive Blvd. Suite 150 St. Louis MO 63141 | |
| (314) 561-9757 | |
| (314) 561-9050 |
| Full Name | The Center For Mindfulness And Cbt, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 10845 Olive Blvd., St. Louis, Missouri |
| Authorized Official Name and Position | Laura Chackes (PRESIDENT) |
| Authorized Official Contact | 3145619757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Center For Mindfulness And Cbt, Llc 10845 Olive Blvd. Suite 150 St. Louis MO 63141 Ph: (314) 561-9757 | The Center For Mindfulness And Cbt, Llc 10845 Olive Blvd. Suite 150 St. Louis MO 63141 Ph: (314) 561-9757 |
| NPI Number | 1013267392 |
|---|---|
| Provider Enumeration Date | 09/14/2012 |
| Last Update Date | 03/09/2017 |
| Medicare PECOS PAC ID | 9032492111 |
|---|---|
| Medicare Enrollment ID | O20170215002401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013267392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | 2006027463 (Missouri) | Primary |
| Provider Name | Laura M Chackes Tonopolsky |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245393081 PECOS PAC ID: 9436225844 Enrollment ID: I20080909000652 |
| Provider Name | Allison N Brauch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972792968 PECOS PAC ID: 7113194598 Enrollment ID: I20120126000051 |
| Provider Name | Deborah Patton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629465661 PECOS PAC ID: 2668753229 Enrollment ID: I20161220001015 |
| Provider Name | Autumn P Roque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184074270 PECOS PAC ID: 1456633130 Enrollment ID: I20170113001354 |
| Provider Name | Jeremy Mark Shuman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881026607 PECOS PAC ID: 7416230511 Enrollment ID: I20170216000049 |
| Provider Name | Jennifer Juanita Marks-foster |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225289721 PECOS PAC ID: 5294092698 Enrollment ID: I20171120001125 |
| Provider Name | Sarah Buday |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780085712 PECOS PAC ID: 0941569347 Enrollment ID: I20180110001412 |
| Provider Name | Molly J Brendle-ayala |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790348464 PECOS PAC ID: 8820325129 Enrollment ID: I20190808003852 |
| Provider Name | Georgia D Bomgardner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568071785 PECOS PAC ID: 9638538655 Enrollment ID: I20230707003090 |
| Provider Name | Andrea Jean Herman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427768894 PECOS PAC ID: 7517313240 Enrollment ID: I20231031003658 |
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