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2451 Executive Dr Ste 103 Saint Charles MO 63303-5606 | |
| (636) 300-9922 | |
| (636) 300-9924 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2451 Executive Dr Ste 103, Saint Charles, Missouri |
| Authorized Official Name and Position | Paul L. Susic (CEO/PRESIDENT) |
| Authorized Official Contact | 6363009922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
350 Trailhead Way Dardenne Prairie MO 63368-7588 Ph: (636) 300-9922 | 2451 Executive Dr Ste 103 Saint Charles MO 63303-5606 Ph: (636) 300-9922 |
| NPI Number | 1871769406 |
|---|---|
| Provider Enumeration Date | 05/04/2008 |
| Last Update Date | 05/04/2008 |
| Medicare PECOS PAC ID | 7719952605 |
|---|---|
| Medicare Enrollment ID | O20080519000235 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871769406 | NPI | - | NPPES |
| 498592518 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 01802 (Missouri) | Primary |
| Provider Name | Glinda M Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679793897 PECOS PAC ID: 0648362517 Enrollment ID: I20070823000055 |
| Provider Name | Amy Marty |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982880548 PECOS PAC ID: 3476622374 Enrollment ID: I20080519000387 |
| Provider Name | William H Kuntz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336122704 PECOS PAC ID: 8628151610 Enrollment ID: I20081208000456 |
| Provider Name | Laura B Jaycox |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285968651 PECOS PAC ID: 6800934357 Enrollment ID: I20091104000044 |
| Provider Name | Clarice Gerke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497051411 PECOS PAC ID: 7113195041 Enrollment ID: I20110720000765 |
| Provider Name | Madeleine K Vatterott Mori |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740562651 PECOS PAC ID: 1254550320 Enrollment ID: I20140923000664 |
Rosebud Family Consultants Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1360 S 5th St, Suite 346, Saint Charles, MO 63301 Phone: 636-724-2922 Fax: 636-724-2928 | |
Lemon Group Wellness Ii, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1925 Bridgecrest Xing, Saint Charles, MO 63303 Phone: 202-643-6190 | |
Mercy Visions Home Healthcare Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3221 Domain St Apt 1, Saint Charles, MO 63301 Phone: 636-294-5089 Fax: 636-614-0766 | |
Rory Ries Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 N 2nd St, Saint Charles, MO 63301 Phone: 636-328-1909 | |
Erin Smith Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1002 Madison St, Saint Charles, MO 63301 Phone: 636-328-2739 Fax: 636-410-8212 |