| St. Louis Behavioral Medicine Institute Inc | |
|
331 Salem Place Ste 225a Fairview Executive Plaza Ii Fairview Heights IL 62208 | |
| (618) 825-0051 | |
| Not Available |
| Full Name | St. Louis Behavioral Medicine Institute Inc |
|---|---|
| Speciality | Counselor |
| Location | 331 Salem Place Ste 225a, Fairview Heights, Illinois |
| Authorized Official Name and Position | Steve Filton (VICE PRESIDENT) |
| Authorized Official Contact | 6107683300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Louis Behavioral Medicine Institute Inc 1129 Macklind Ave Saint Louis MO 63110-1440 Ph: (314) 881-3446 | St. Louis Behavioral Medicine Institute Inc 331 Salem Place Ste 225a Fairview Executive Plaza Ii Fairview Heights IL 62208 Ph: (618) 825-0051 |
| NPI Number | 1952169179 |
|---|---|
| Provider Enumeration Date | 03/12/2024 |
| Last Update Date | 03/12/2024 |
| Certification Date | 03/12/2024 |
| Medicare PECOS PAC ID | 3173428638 |
|---|---|
| Medicare Enrollment ID | O20240510000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952169179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| Provider Name | Kathy J Corn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689769119 PECOS PAC ID: 4880035666 Enrollment ID: I20240510000734 |
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