Provider Demographics
NPI:1003146358
Name:THE RELATIONSHIP CENTER OF ST. LOUIS
Entity Type:Organization
Organization Name:THE RELATIONSHIP CENTER OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-276-5622
Mailing Address - Street 1:7292 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-2438
Mailing Address - Country:US
Mailing Address - Phone:314-659-8330
Mailing Address - Fax:314-659-8330
Practice Address - Street 1:7292 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-2438
Practice Address - Country:US
Practice Address - Phone:314-659-8330
Practice Address - Fax:314-659-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000165547261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)