| Family Life Counseling And Psychological Services, Llc | |
|
4142 Keaton Crossing Blvd Suite 101 O Fallon MO 63368-8404 | |
| (636) 300-9333 | |
| (636) 300-8761 |
| Full Name | Family Life Counseling And Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4142 Keaton Crossing Blvd, O Fallon, Missouri |
| Authorized Official Name and Position | David Sanderson (MANAGER) |
| Authorized Official Contact | 6363009333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Life Counseling And Psychological Services, Llc 4142 Keaton Crossing Blvd Suite 101 O Fallon MO 63368-8404 Ph: (636) 300-9333 | Family Life Counseling And Psychological Services, Llc 4142 Keaton Crossing Blvd Suite 101 O Fallon MO 63368-8404 Ph: (636) 300-9333 |
| NPI Number | 1851459473 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 5496649022 |
|---|---|
| Medicare Enrollment ID | O20040212000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851459473 | NPI | - | NPPES |
| 165530 | Other | MO | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 2000166718 (Missouri) | Primary |
| Provider Name | Lisa D Mcgrath |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033354501 PECOS PAC ID: 0143114660 Enrollment ID: I20040213000270 |
| Provider Name | Susan L Sanderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487717963 PECOS PAC ID: 5294629838 Enrollment ID: I20120222000456 |
| Provider Name | Katie A Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659671832 PECOS PAC ID: 7810155488 Enrollment ID: I20120229000026 |
| Provider Name | Christopher J Derix |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689998221 PECOS PAC ID: 8921250689 Enrollment ID: I20121204000520 |
| Provider Name | Jacqueline Ann Weydert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871752436 PECOS PAC ID: 7012072192 Enrollment ID: I20170613001570 |
| Provider Name | Dustin B Adamo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164760062 PECOS PAC ID: 7012240229 Enrollment ID: I20190603001850 |
| Provider Name | Cynthia L Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528672383 PECOS PAC ID: 4284052093 Enrollment ID: I20200910002210 |
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