Organization
INDEPENDENCE CENTER
Active
Other names
Independence Center Health Group, Independence Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA HOLMES (EXECUTIVE DIRECTOR)
(314) 880-5415
Entity
Organization
Contact information
Practice address
4245 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 286-4545
(314) 286-4542
Mailing address
4245 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 880-5401
(314) 880-5468
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
225X00000X
Occupational Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503350506
—
MO
05
—
560003943
—
MO
Enumeration date
02/20/2007
Last updated
03/18/2026
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