Provider Demographics
NPI:1437347234
Name:ANAT RESCHKE, PH.D., LLC
Entity Type:Organization
Organization Name:ANAT RESCHKE, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RESCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-569-2525
Mailing Address - Street 1:10420 OLD OLIVE STREET RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-991-9700
Mailing Address - Fax:314-991-7779
Practice Address - Street 1:10420 OLD OLIVE STREET RD.
Practice Address - Street 2:SUITE 202
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-991-9700
Practice Address - Fax:314-991-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO149532OtherBLUE CROSS BLUE SHIELD
MO466844OtherHEALTHLINK
MO149532OtherBLUE CROSS BLUE SHIELD
MO466844OtherHEALTHLINK