Provider Demographics
NPI:1164631495
Name:ST. CHARLES PSYCHIATRIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:ST. CHARLES PSYCHIATRIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-949-5760
Mailing Address - Street 1:4801 WELDON SPRING PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-9101
Mailing Address - Country:US
Mailing Address - Phone:636-949-5760
Mailing Address - Fax:866-440-9231
Practice Address - Street 1:4801 WELDON SPRING PKWY STE 300
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9101
Practice Address - Country:US
Practice Address - Phone:636-949-5760
Practice Address - Fax:866-440-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty