| Community And Long-term Care Psychiatry Llc | |
|
10004 Kennerly Rd Ste 362b Saint Louis MO 63128-2178 | |
| (314) 525-5050 | |
| (314) 525-5072 |
| Full Name | Community And Long-term Care Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10004 Kennerly Rd Ste 362b, Saint Louis, Missouri |
| Authorized Official Name and Position | Ernest Alexander Graypel (OWNER) |
| Authorized Official Contact | 3142671075 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community And Long-term Care Psychiatry Llc 10004 Kennerly Rd Ste 362b Saint Louis MO 63128-2178 Ph: (314) 525-5050 | Community And Long-term Care Psychiatry Llc 10004 Kennerly Rd Ste 362b Saint Louis MO 63128-2178 Ph: (314) 525-5050 |
| NPI Number | 1699121475 |
|---|---|
| Provider Enumeration Date | 05/10/2016 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Medicare PECOS PAC ID | 4486949773 |
|---|---|
| Medicare Enrollment ID | O20160825001678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699121475 | NPI | - | NPPES |
| 1265723407 | Medicaid | MO | |
| 156440095 | Other | MO | MEDICARE |
| P01585490 | Other | MO | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0015X | Psychiatry & Neurology - Psychosomatic Medicine | 2015002634 (Missouri) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 2015002634 (Missouri) | Primary |
| Provider Name | Anita Mehra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144371568 PECOS PAC ID: 0143271494 Enrollment ID: I20050203000976 |
| Provider Name | Julie E Lafferty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710097126 PECOS PAC ID: 0547455073 Enrollment ID: I20101110000838 |
| Provider Name | Alexander E Graypel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871804914 PECOS PAC ID: 8325369812 Enrollment ID: I20150609002406 |
| Provider Name | Ernest A Graypel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265723407 PECOS PAC ID: 4082926480 Enrollment ID: I20150626000812 |
| Provider Name | Betty Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104241835 PECOS PAC ID: 6507170511 Enrollment ID: I20150805006441 |
| Provider Name | Erica Vogler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972049138 PECOS PAC ID: 9436410339 Enrollment ID: I20180308002215 |
| Provider Name | Jennifer K Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942518261 PECOS PAC ID: 6002051968 Enrollment ID: I20180618001814 |
| Provider Name | Erum Qazi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043625932 PECOS PAC ID: 3577865021 Enrollment ID: I20180814004092 |
| Provider Name | David Landau |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346419884 PECOS PAC ID: 3870837693 Enrollment ID: I20181205002789 |
| Provider Name | Angela Jean Farris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760726012 PECOS PAC ID: 6709122757 Enrollment ID: I20191230000890 |
| Provider Name | Tamara A Hoyt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831235720 PECOS PAC ID: 2668669300 Enrollment ID: I20201023001936 |
| Provider Name | Chia-yu Lien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992132476 PECOS PAC ID: 4789816463 Enrollment ID: I20210519002435 |
| Provider Name | Jacqueline Elise Kirk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326719964 PECOS PAC ID: 3678964772 Enrollment ID: I20211228001689 |
| Provider Name | Cindy Aug |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124523659 PECOS PAC ID: 3476961756 Enrollment ID: I20220317001496 |
| Provider Name | Jodie Shipley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811603376 PECOS PAC ID: 5890150197 Enrollment ID: I20230419002965 |
| Provider Name | Caleb James Berg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144908328 PECOS PAC ID: 1456706548 Enrollment ID: I20231010001041 |
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