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Organization

ELITE PSYCHIATRIC SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SHANNON MICHELLE JENNINGS M.D. (PHYSICIAN)
(636) 484-0632
Entity
Organization

Contact information

Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6119
(314) 653-5370
(314) 653-5399
Mailing address
1836 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3572
(314) 872-1439

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2004001640
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
504045402
MO
01
DF9548
RR MEDICARE GROUP#
MO
Enumeration date
07/11/2007
Last updated
09/22/2010
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