Provider Demographics
NPI:1366076721
Name:MIDWEST PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:MIDWEST PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JAND
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-498-0372
Mailing Address - Street 1:220 W ARGONNE DR STE B
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4237
Mailing Address - Country:US
Mailing Address - Phone:314-319-3148
Mailing Address - Fax:888-920-1342
Practice Address - Street 1:220 W ARGONNE DR STE B
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4237
Practice Address - Country:US
Practice Address - Phone:314-319-3148
Practice Address - Fax:888-920-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health