| Jay L. Liss, Incorporated | |
|
8711 Watson Rd Suite 100 Saint Louis MO 63119-5100 | |
| (314) 961-9871 | |
| (314) 961-9877 |
| Full Name | Jay L. Liss, Incorporated |
|---|---|
| Speciality | Counselor |
| Location | 8711 Watson Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Jay L Liss (PRESIDENT) |
| Authorized Official Contact | 3149619871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jay L. Liss, Incorporated 8711 Watson Rd Suite 100 Saint Louis MO 63119-5100 Ph: (314) 961-9871 | Jay L. Liss, Incorporated 8711 Watson Rd Suite 100 Saint Louis MO 63119-5100 Ph: (314) 961-9871 |
| NPI Number | 1982777454 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 04/25/2008 |
| Medicare PECOS PAC ID | 7214014885 |
|---|---|
| Medicare Enrollment ID | O20080407000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982777454 | NPI | - | NPPES |
| 000015640 | Other | MO | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jay L Liss |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679584494 PECOS PAC ID: 7416947502 Enrollment ID: I20040512000890 |
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