| Kezia E Coleman Psyd Llc | |
|
7777 Bonhomme Ave Ste 1800 Clayton MO 63105-1931 | |
| (314) 472-3091 | |
| Not Available |
| Full Name | Kezia E Coleman Psyd Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7777 Bonhomme Ave Ste 1800, Clayton, Missouri |
| Authorized Official Name and Position | Kezia Jackson (OWNER) |
| Authorized Official Contact | 3144723091 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kezia E Coleman Psyd Llc 7711 Bonhomme Ave Ste 720 Clayton MO 63105-1908 Ph: (314) 472-3091 | Kezia E Coleman Psyd Llc 7777 Bonhomme Ave Ste 1800 Clayton MO 63105-1931 Ph: (314) 472-3091 |
| NPI Number | 1427673367 |
|---|---|
| Provider Enumeration Date | 06/16/2020 |
| Last Update Date | 09/21/2023 |
| Certification Date | 09/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427673367 | NPI | - | NPPES |
| 1346600061 | Medicaid | MO | |
| 1790233153 | Medicaid | MO | |
| 1992030027 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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