Individual
THERESA R BAJT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
777 CRAIG RD, SUITE 130, CREVE COEUR, MO 63141-7138
(314) 872-7792
(314) 872-5655
Mailing address
777 CRAIG RD, SUITE 130, CREVE COEUR, MO 63141-7138
(314) 872-7792
(314) 872-5655
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2005003277
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201124
BCBS
MO
05
—
494052608
—
MO
Enumeration date
10/04/2006
Last updated
01/09/2012
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