Provider Demographics
NPI:1093430944
Name:DEPRESSION CLINIC AT THE HEALTH CENTERS
Entity Type:Organization
Organization Name:DEPRESSION CLINIC AT THE HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, EMT-B, CTMS
Authorized Official - Phone:636-946-2244
Mailing Address - Street 1:2621 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4872
Mailing Address - Country:US
Mailing Address - Phone:636-946-2244
Mailing Address - Fax:636-946-6975
Practice Address - Street 1:2621 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4872
Practice Address - Country:US
Practice Address - Phone:636-946-2244
Practice Address - Fax:636-946-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203861919Medicaid