Provider Demographics
NPI:1093881252
Name:GOOD SHEPHERD CHILDREN AND FAMILY SERVICES
Entity Type:Organization
Organization Name:GOOD SHEPHERD CHILDREN AND FAMILY SERVICES
Other - Org Name:MARIAN HALL AGENCIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-854-5737
Mailing Address - Street 1:1340 PARTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1943
Mailing Address - Country:US
Mailing Address - Phone:314-854-5737
Mailing Address - Fax:314-854-5750
Practice Address - Street 1:1340 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1943
Practice Address - Country:US
Practice Address - Phone:314-854-5737
Practice Address - Fax:314-854-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children