Provider Demographics
NPI:1497065585
Name:PETINA COLLIER LINDSEY
Entity Type:Organization
Organization Name:PETINA COLLIER LINDSEY
Other - Org Name:LINDSEY THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETINA
Authorized Official - Middle Name:COLLIER
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:314-322-3326
Mailing Address - Street 1:2536 OLD HIGHWAY 94 S.
Mailing Address - Street 2:SUITE #220
Mailing Address - City:ST.. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5612
Mailing Address - Country:US
Mailing Address - Phone:636-922-2000
Mailing Address - Fax:636-329-0994
Practice Address - Street 1:2536 OLD HIGHWAY 94 S.
Practice Address - Street 2:SUITE #220
Practice Address - City:ST.. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5612
Practice Address - Country:US
Practice Address - Phone:636-922-2000
Practice Address - Fax:636-329-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0056991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494653421Medicaid
MOMA2556OtherMEDICARE