Provider Demographics
NPI:1497326466
Name:BOYS HOPE GIRLS HOPE OF ST. LOUIS, INC.
Entity Type:Organization
Organization Name:BOYS HOPE GIRLS HOPE OF ST. LOUIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LPC
Authorized Official - Phone:314-776-9406
Mailing Address - Street 1:8027 ELINOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-776-9406
Mailing Address - Fax:314-776-9406
Practice Address - Street 1:8027 ELINOR AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-776-9406
Practice Address - Fax:314-776-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management