| Tofbc, Llc | |
|
1000 Lake Saint Louis Blvd Suite 261 Lake Saint Louis MO 63367-1340 | |
| (636) 561-0268 | |
| (636) 625-1580 |
| Full Name | Tofbc, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1000 Lake Saint Louis Blvd, Lake Saint Louis, Missouri |
| Authorized Official Name and Position | Vicky Lynn Glass (THERAPIST, MEMBER OF TOFBC, LLC) |
| Authorized Official Contact | 6365610268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tofbc, Llc 1000 Lake Saint Louis Blvd Suite 261 Lake Saint Louis MO 63367-1340 Ph: (636) 561-0268 | Tofbc, Llc 1000 Lake Saint Louis Blvd Suite 261 Lake Saint Louis MO 63367-1340 Ph: (636) 561-0268 |
| NPI Number | 1881723773 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881723773 | NPI | - | NPPES |
| 495246514 (46,47,48) | Medicaid | MO | |
| 152189 | Other | MO | ANTHEM BCBS ID# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2001020554 (Missouri) | Primary |
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