Provider Demographics
NPI:1043814874
Name:THE NEUROPSYCHOLOGY CENTER OF ST. LOUIS
Entity Type:Organization
Organization Name:THE NEUROPSYCHOLOGY CENTER OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-324-3800
Mailing Address - Street 1:425 N NEW BALLAS RD STE 290
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6852
Mailing Address - Country:US
Mailing Address - Phone:314-324-3800
Mailing Address - Fax:314-260-7676
Practice Address - Street 1:425 N NEW BALLAS RD STE 290
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6852
Practice Address - Country:US
Practice Address - Phone:314-324-3800
Practice Address - Fax:314-260-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty