Individual
MICHELLE LYNN JOCHIM BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3800 PARK AVE, SAINT LOUIS, MO 63110-2514
(314) 577-5667
(314) 268-2784
Mailing address
3800 PARK AVE, SAINT LOUIS, MO 63110-2514
(314) 577-5667
(314) 268-2784
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2015035134
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20042867A
MEDICAL LICENSE
IN
01
—
2015035134
MEDICAL LICENSE
MO
Enumeration date
11/05/2015
Last updated
11/10/2020
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