Provider Demographics
NPI:1013267392
Name:THE CENTER FOR MINDFULNESS AND CBT, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR MINDFULNESS AND CBT, LLC
Other - Org Name:LAURA CHACKES PSY D LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:314-561-9757
Mailing Address - Street 1:10845 OLIVE BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-561-9757
Mailing Address - Fax:314-561-9050
Practice Address - Street 1:10845 OLIVE BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-561-9757
Practice Address - Fax:314-561-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006027463103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty