Provider Demographics
NPI:1780749457
Name:ST LOUIS BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity type:Organization
Organization Name:ST LOUIS BEHAVIORAL HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KULSOOM
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:JUNAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-922-2662
Mailing Address - Street 1:11 SUMMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8408
Mailing Address - Country:US
Mailing Address - Phone:314-922-2662
Mailing Address - Fax:314-251-5897
Practice Address - Street 1:1400 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2408
Practice Address - Country:US
Practice Address - Phone:314-776-7999
Practice Address - Fax:314-772-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-23
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010171512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty