Provider Demographics
NPI:1841743317
Name:PSYCHOLOGICAL SERVICES OF ST. LOUIS, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF ST. LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-884-8075
Mailing Address - Street 1:7110 OAKLAND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1868
Mailing Address - Country:US
Mailing Address - Phone:314-884-0779
Mailing Address - Fax:314-227-9327
Practice Address - Street 1:7110 OAKLAND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1868
Practice Address - Country:US
Practice Address - Phone:314-884-0779
Practice Address - Fax:314-227-9327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010030791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty