Provider Demographics
NPI:1427155340
Name:CAUL, JEFFERIES (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFERIES
Middle Name:
Last Name:CAUL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N CLAY AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4205
Mailing Address - Country:US
Mailing Address - Phone:314-800-5381
Mailing Address - Fax:314-894-3836
Practice Address - Street 1:108 N CLAY AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-4205
Practice Address - Country:US
Practice Address - Phone:314-800-5381
Practice Address - Fax:314-894-3836
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical