Provider Demographics
NPI:1548205024
Name:ATTENTION DEFICIT CENTER LLC
Entity Type:Organization
Organization Name:ATTENTION DEFICIT CENTER LLC
Other - Org Name:AFFILIATED PSYCHOTHERAPIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TENENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-991-7779
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 334 E.
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-991-7779
Mailing Address - Fax:314-991-7779
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 334 E.
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-991-7779
Practice Address - Fax:314-991-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001551101YP2500X
MOPY01309103TC0700X
MOSW0004671041C0700X
MOSW0012861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12204OtherBLUE CROSS BLUE SHIELD PR