| Provident Behavioral Health | |
|
2650 Olive St Saint Louis MO 63103-1424 | |
| (314) 371-6500 | |
| (314) 371-1155 |
| Full Name | Provident Behavioral Health |
|---|---|
| Speciality | Counselor |
| Location | 2650 Olive St, Saint Louis, Missouri |
| Authorized Official Name and Position | Kathy S Schlemmer (RELATIONS COORDINATOR) |
| Authorized Official Contact | 3148022647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Behavioral Health 2650 Olive St Saint Louis MO 63103-1424 Ph: (314) 371-6500 | Provident Behavioral Health 2650 Olive St Saint Louis MO 63103-1424 Ph: (314) 371-6500 |
| NPI Number | 1710023791 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 10/05/2022 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 0345217279 |
|---|---|
| Medicare Enrollment ID | O20050407000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710023791 | NPI | - | NPPES |
| MA5670 | Other | MO | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Brooke Hanna Justis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942591169 PECOS PAC ID: 9133349921 Enrollment ID: I20140929002432 |
| Provider Name | Tanja M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447654827 PECOS PAC ID: 1254653652 Enrollment ID: I20141212001157 |
| Provider Name | Nahnahsha J Deas Elmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457627614 PECOS PAC ID: 2365730942 Enrollment ID: I20161014000035 |
| Provider Name | Stacy L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174002232 PECOS PAC ID: 5991057671 Enrollment ID: I20181008001380 |
| Provider Name | Elizabeth Ann Reinberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669759783 PECOS PAC ID: 3779828660 Enrollment ID: I20181220003400 |
| Provider Name | Jennifer J. Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194221200 PECOS PAC ID: 5890033591 Enrollment ID: I20190205000280 |
| Provider Name | Megan E Bax |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336531631 PECOS PAC ID: 5092073023 Enrollment ID: I20200225001389 |
| Provider Name | Courtney Paige Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639796766 PECOS PAC ID: 0143647479 Enrollment ID: I20200901000504 |
| Provider Name | Alexander Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881289510 PECOS PAC ID: 9931516549 Enrollment ID: I20210326001953 |
| Provider Name | Victoria N Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568945020 PECOS PAC ID: 0042686800 Enrollment ID: I20221019000936 |
| Provider Name | Dayton J Nelsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417670654 PECOS PAC ID: 1254700578 Enrollment ID: I20221208002039 |
| Provider Name | Guadalupe Murillo Wink |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629783972 PECOS PAC ID: 6406229087 Enrollment ID: I20230301001882 |
| Provider Name | Melissa Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174246441 PECOS PAC ID: 1658729124 Enrollment ID: I20231121002922 |
| Provider Name | Karolyn Marie Ratliff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508596461 PECOS PAC ID: 4082061510 Enrollment ID: I20231121003058 |
| Provider Name | Sarah E Paradise |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427594548 PECOS PAC ID: 5799133096 Enrollment ID: I20231128000379 |
| Provider Name | Jaskirat Kaur |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518587849 PECOS PAC ID: 6709234024 Enrollment ID: I20231128001246 |
| Provider Name | Cynthia A Jung |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073145900 PECOS PAC ID: 0547618878 Enrollment ID: I20231128001552 |
| Provider Name | Samantha Jane Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124613005 PECOS PAC ID: 0042668386 Enrollment ID: I20231128001765 |
| Provider Name | Gabriella Santos Francisco |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386262541 PECOS PAC ID: 6800244393 Enrollment ID: I20231128002040 |
| Provider Name | Karen B Gabriel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689070153 PECOS PAC ID: 8224486469 Enrollment ID: I20231128002155 |
| Provider Name | Tracie Marie Striebel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467040949 PECOS PAC ID: 6406204643 Enrollment ID: I20231128002187 |
| Provider Name | Daniel Michael Dwyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023698982 PECOS PAC ID: 2567810039 Enrollment ID: I20231130000739 |
| Provider Name | Rachel J Welch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255088779 PECOS PAC ID: 0941652150 Enrollment ID: I20240123002883 |
| Provider Name | Angela Wallace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417435819 PECOS PAC ID: 1850735150 Enrollment ID: I20240214002965 |
| Provider Name | Brenda Alexia Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619535986 PECOS PAC ID: 5991139388 Enrollment ID: I20240424003235 |
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