Organization
INDEPENDENCE CENTER
Active
Other names
Independence Center Health Group, Midwest Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA HOLMES (EXECUTIVE DIRECTOR)
(314) 880-5415
Entity
Organization
Contact information
Practice address
4219 LACLEDE AVE, SAINT LOUIS, MO 63108-2814
(314) 880-5415
(314) 880-5468
Mailing address
4245 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 880-5415
(314) 880-5468
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
560003943
—
MO
Enumeration date
06/27/2013
Last updated
06/27/2022
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