Organization
COMMUNITY & LONG-TERM CARE PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTY JANE DICKERMAN (BILLING MANAGER)
(314) 849-0450
Entity
Organization
Contact information
Practice address
10004 KENNERLY RD, STE 362B, SAINT LOUIS, MO 63128-2141
(314) 849-0450
(314) 849-0159
Mailing address
10004 KENNERLY RD, STE 362B, SAINT LOUIS, MO 63128-2141
(314) 849-0450
(314) 849-0159
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2015002634
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265723407
—
MO
Enumeration date
05/19/2016
Last updated
05/19/2016
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