| Psychotherapy Llc | |
|
508 N Truman Blvd Ste F Crystal City MO 63019-1344 | |
| (636) 931-8784 | |
| (636) 465-0026 |
| Full Name | Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 508 N Truman Blvd Ste F, Crystal City, Missouri |
| Authorized Official Name and Position | Diana Blackwell (CEO) |
| Authorized Official Contact | 5733155549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy Llc 508 N Truman Blvd Ste F Crystal City MO 63019-1344 Ph: (636) 931-8784 | Psychotherapy Llc 508 N Truman Blvd Ste F Crystal City MO 63019-1344 Ph: (636) 931-8784 |
| NPI Number | 1164203188 |
|---|---|
| Provider Enumeration Date | 10/06/2023 |
| Last Update Date | 04/11/2024 |
| Certification Date | 04/11/2024 |
| Medicare PECOS PAC ID | 0143769828 |
|---|---|
| Medicare Enrollment ID | O20240826002840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164203188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Diana L Blackwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811088446 PECOS PAC ID: 1456509645 Enrollment ID: I20120912000867 |
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