Provider Demographics
NPI:1548567670
Name:STOREY, BENJAMIN (BA)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:STOREY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6195
Mailing Address - Country:US
Mailing Address - Phone:314-206-3464
Mailing Address - Fax:
Practice Address - Street 1:343 S KIRKWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6195
Practice Address - Country:US
Practice Address - Phone:314-206-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical