Organization
GREAT CIRCLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA RICKER FLEMING PHD (PRESIDENT & CEO)
(573) 356-0022
Entity
Organization
Contact information
Practice address
1212 W LOMBARD ST, SPRINGFIELD, MO 65806-2720
(844) 424-3577
(314) 919-4876
Mailing address
330 N GORE AVE, SAINT LOUIS, MO 63119-1600
(844) 424-3577
(314) 919-4876
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507009603
—
MO
Enumeration date
06/27/2022
Last updated
07/04/2022
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