Provider Demographics
NPI:1972791531
Name:ST. LOUIS BEHAVIORAL ASSOCIATES LTD.
Entity type:Organization
Organization Name:ST. LOUIS BEHAVIORAL ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MOERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-997-1183
Mailing Address - Street 1:745 CRAIG RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7160
Mailing Address - Country:US
Mailing Address - Phone:314-997-1183
Mailing Address - Fax:314-997-1196
Practice Address - Street 1:745 CRAIG RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7160
Practice Address - Country:US
Practice Address - Phone:314-997-1183
Practice Address - Fax:314-997-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
29171OtherBCBS
MOR00953Medicare UPIN
MO990001186Medicare PIN