Provider Demographics
NPI:1790072262
Name:BJC BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:BJC BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DOCKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:314-308-2508
Mailing Address - Street 1:3165 MCKELVEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2550
Mailing Address - Country:US
Mailing Address - Phone:314-206-3900
Mailing Address - Fax:
Practice Address - Street 1:3165 MCKELVEY RD STE 200
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2550
Practice Address - Country:US
Practice Address - Phone:314-206-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health