Provider Demographics
NPI:1235111501
Name:POLITTE, ALAN J (EDD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:POLITTE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6323
Mailing Address - Country:US
Mailing Address - Phone:314-878-8855
Mailing Address - Fax:
Practice Address - Street 1:1023 EXECUTIVE PARKWAY DR
Practice Address - Street 2:SUITE 8
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6323
Practice Address - Country:US
Practice Address - Phone:314-878-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical