Provider Demographics
NPI:1174147615
Name:OMALLEY, JAMES THOMAS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:OMALLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3841
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:
Practice Address - Street 1:5138 OLDE SILVER PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2907
Practice Address - Country:US
Practice Address - Phone:314-640-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008024640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health