| Positive Family Living | |
|
745 Craig Road Saint Louis MO 63141-7122 | |
| (314) 729-2855 | |
| (314) 529-3534 |
| Full Name | Positive Family Living |
|---|---|
| Speciality | Psychologist |
| Location | 745 Craig Road, Saint Louis, Missouri |
| Authorized Official Name and Position | Alice G Vlietstra (OWNER) |
| Authorized Official Contact | 3147292855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Family Living 3042 Andover Dr Saint Louis MO 63121-4606 Ph: (314) 729-2855 | Positive Family Living 745 Craig Road Saint Louis MO 63141-7122 Ph: (314) 729-2855 |
| NPI Number | 1568732550 |
|---|---|
| Provider Enumeration Date | 01/06/2012 |
| Last Update Date | 12/15/2022 |
| Certification Date | 12/15/2022 |
| Medicare PECOS PAC ID | 1456510973 |
|---|---|
| Medicare Enrollment ID | O20120301000843 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568732550 | NPI | - | NPPES |
| 075243 | Other | MO | VALUE OPTIONS |
| 1601 | Other | MO | BLUE DROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | PY01089 (Missouri) | Primary |
| 106H00000X | Marriage & Family Therapist | 300075 (Missouri) | Secondary |
| Provider Name | Alice G Vlietstra |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841324753 PECOS PAC ID: 9537328059 Enrollment ID: I20120301000855 |
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