Provider Demographics
NPI:1124580501
Name:OPEN GATE THERAPY LLC
Entity Type:Organization
Organization Name:OPEN GATE THERAPY LLC
Other - Org Name:OPEN GATE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-498-7327
Mailing Address - Street 1:5602 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1518
Mailing Address - Country:US
Mailing Address - Phone:314-498-7327
Mailing Address - Fax:
Practice Address - Street 1:6220 S LINDBERGH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7839
Practice Address - Country:US
Practice Address - Phone:314-498-7327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONAOtherNA