Provider Demographics
NPI:1265593040
Name:COADY, BRIAN A (MSW LCSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:COADY
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HERITAGE LANDING
Mailing Address - Street 2:SUITE 212C
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304
Mailing Address - Country:US
Mailing Address - Phone:636-345-1400
Mailing Address - Fax:636-441-3262
Practice Address - Street 1:1600 HERITAGE LANDING
Practice Address - Street 2:SUITE 212C
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-345-1400
Practice Address - Fax:630-441-3262
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050012111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical