Provider Demographics
NPI:1114396330
Name:GAFFREY, MICHAEL S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:GAFFREY
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8134
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-286-1799
Practice Address - Street 1:4444 FOREST PARK AVE STE 2600
Practice Address - Street 2:STE 2600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-286-1799
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010039559103TC2200X, 103TM1800X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities