Provider Demographics
NPI:1588978688
Name:ST. LOUIS COUNTY GOVERNMENT
Entity type:Organization
Organization Name:ST. LOUIS COUNTY GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ST. LOUIS CO HS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:314-615-4453
Mailing Address - Street 1:21 SOUTH CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:314-615-4453
Mailing Address - Fax:
Practice Address - Street 1:4201 MCKIBBON RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:MO
Practice Address - Zip Code:63134-3217
Practice Address - Country:US
Practice Address - Phone:314-423-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LOUIS COUNTY HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035751101YP2500X
MO0021021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty