Individual
RAYMOND C TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1221 S GRAND, ST LOUIS, MO 63104
(314) 268-5424
(314) 268-5736
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01087
MO
Other
Enumeration date
02/14/2006
Last updated
01/09/2008
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