Organization
PHOENIX PSYCHOLOGICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA S SHAW PHD (PRESIDENT)
(314) 863-3588
Entity
Organization
Contact information
Practice address
225 S MERAMEC AVE, SUITE 506, SAINT LOUIS, MO 63105-3596
(314) 863-3588
(314) 863-0074
Mailing address
225 S MERAMEC AVE, SUITE 506, SAINT LOUIS, MO 63105-3596
(314) 863-3588
(314) 863-0074
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
PY01201
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245254317
NPI-PATRICIA SHAW
MO
05
—
493257802
—
MO
Enumeration date
04/09/2007
Last updated
08/22/2020
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