Organization
INDEPENDENCE CENTER
Active
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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