Provider Demographics
NPI:1992155006
Name:ST. LOUIS THERAPEUTIC ALLIANCE LLC
Entity type:Organization
Organization Name:ST. LOUIS THERAPEUTIC ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRAADC
Authorized Official - Phone:314-249-6922
Mailing Address - Street 1:2 FOXCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4233
Mailing Address - Country:US
Mailing Address - Phone:314-249-6922
Mailing Address - Fax:314-222-6319
Practice Address - Street 1:9890 CLAYTON RD
Practice Address - Street 2:SUITE 127
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-249-6922
Practice Address - Fax:314-222-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health