Provider Demographics
NPI:1639494891
Name:WEBSTER WELLNESS PROFESSIONALS INC
Entity Type:Organization
Organization Name:WEBSTER WELLNESS PROFESSIONALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLANERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-737-4070
Mailing Address - Street 1:231 W LOCKWOOD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2951
Mailing Address - Country:US
Mailing Address - Phone:314-737-4070
Mailing Address - Fax:314-737-4071
Practice Address - Street 1:231 W LOCKWOOD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2951
Practice Address - Country:US
Practice Address - Phone:314-737-4070
Practice Address - Fax:314-737-4071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCALLUM GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-31
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORO282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty