Provider Demographics
NPI:1609923689
Name:VILLAFLORES, THERESA JOY (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:JOY
Last Name:VILLAFLORES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-286-1777
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV CHILD AND ADOLESCENT PSYCHIATRY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-286-1777
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040189272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207260209Medicaid
MOBN7519234OtherDEA
MO000092511Medicaid
MO123766Medicare ID - Type Unspecified