Provider Demographics
NPI:1790346542
Name:ART MAINES, LCSW LLC
Entity Type:Organization
Organization Name:ART MAINES, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:MAINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-565-6881
Mailing Address - Street 1:1121 OLIVETTE EXECUTIVE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3254
Mailing Address - Country:US
Mailing Address - Phone:314-565-6881
Mailing Address - Fax:314-872-8033
Practice Address - Street 1:1121 OLIVETTE EXECUTIVE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3254
Practice Address - Country:US
Practice Address - Phone:314-565-6881
Practice Address - Fax:314-872-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427143304OtherNPPES