Provider Demographics
NPI:1205052727
Name:DR ARDEKANIS STRESS CLINIC, PC
Entity type:Organization
Organization Name:DR ARDEKANIS STRESS CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:BEHESHTI
Authorized Official - Last Name:ARDEKANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-843-3310
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 310A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-843-3310
Mailing Address - Fax:314-843-8825
Practice Address - Street 1:SUITE 310A
Practice Address - Street 2:10004 KENNERLY RD
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5117
Practice Address - Country:US
Practice Address - Phone:314-843-3310
Practice Address - Fax:314-843-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO359412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
181942OtherALLIANCE BCBS
260004802498769OtherTRICARE NORTH REGION
MO504612003Medicaid
260004802OtherRR MEDICARE PART B
12031OtherCIGNA GENERAL MOTORS
31744OtherCMR CARE MANAGEMENT RESOU
9534OtherBCBS OF MISSOURI
015927000OtherMAGELLAN BEHAVIORAL HEALT
101010OtherHEALTHLINK
129999OtherVALUE OPTIONS
A10513OtherMERCY HEALTH PLAN
31744OtherGROUP HEALTH PLAN
1542794OtherUNITED BEHAVIORAL HEALTH
198301OtherVALUE BEHAVIORAL HEALTH
MO000015560Medicare PIN