Provider Demographics
NPI:1043491020
Name:PROVIDENT INC
Entity Type:Organization
Organization Name:PROVIDENT INC
Other - Org Name:PROVIDENT BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RELATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-802-2647
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1424
Mailing Address - Country:US
Mailing Address - Phone:314-371-6500
Mailing Address - Fax:314-371-1155
Practice Address - Street 1:2650 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1489
Practice Address - Country:US
Practice Address - Phone:314-371-6500
Practice Address - Fax:314-371-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty