Provider Demographics
NPI:1194140756
Name:EMERGENCE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:EMERGENCE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMECA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODY-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-800-4215
Mailing Address - Street 1:8000 BONHOMME AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3515
Mailing Address - Country:US
Mailing Address - Phone:314-800-4215
Mailing Address - Fax:949-863-5179
Practice Address - Street 1:1131 THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1227
Practice Address - Country:US
Practice Address - Phone:314-800-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1378481103TC1900X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty