| Sandydavislpc Llc | |
|
13023 Tesson Ferry Rd Ste 103 Saint Louis MO 63128-3480 | |
| (636) 232-0340 | |
| (636) 600-8714 |
| Full Name | Sandydavislpc Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 13023 Tesson Ferry Rd Ste 103, Saint Louis, Missouri |
| Authorized Official Name and Position | Sandra Davis (OWNER/COUNSELOR) |
| Authorized Official Contact | 6362320340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandydavislpc Llc 13023 Tesson Ferry Rd Ste 103 Saint Louis MO 63128-3480 Ph: (636) 232-0340 | Sandydavislpc Llc 13023 Tesson Ferry Rd Ste 103 Saint Louis MO 63128-3480 Ph: (636) 232-0340 |
| NPI Number | 1174393573 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 01/23/2024 |
| Certification Date | 01/18/2024 |
| Medicare PECOS PAC ID | 1052758919 |
|---|---|
| Medicare Enrollment ID | O20240327002037 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174393573 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sandra Ann Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851619308 PECOS PAC ID: 2961849823 Enrollment ID: I20240327002147 |
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