Provider Demographics
NPI:1821342445
Name:CHERIE BAETZ-DAVIS, PH.D., LLC
Entity Type:Organization
Organization Name:CHERIE BAETZ-DAVIS, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAETZ-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-804-3624
Mailing Address - Street 1:211 CARROLLTON LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1225
Mailing Address - Country:US
Mailing Address - Phone:314-804-3624
Mailing Address - Fax:314-804-5336
Practice Address - Street 1:331 N NEW BALLAS RD UNIT 410062
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-0062
Practice Address - Country:US
Practice Address - Phone:314-804-3624
Practice Address - Fax:314-804-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496975814Medicaid
MO496975814Medicaid
MOP13834Medicare UPIN