Provider Demographics
NPI:1659301562
Name:GAFFORD GENERAL PRACTICES, LLC
Entity Type:Organization
Organization Name:GAFFORD GENERAL PRACTICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-275-7802
Mailing Address - Street 1:1000 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6325
Mailing Address - Country:US
Mailing Address - Phone:314-275-7802
Mailing Address - Fax:314-275-7801
Practice Address - Street 1:1000 EXECUTIVE PARKWAY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6325
Practice Address - Country:US
Practice Address - Phone:314-275-7802
Practice Address - Fax:314-275-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031420103TC0700X
MO2004013906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty