Provider Demographics
NPI:1366437196
Name:BAETZ-DAVIS, CHERIE A (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:A
Last Name:BAETZ-DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CARROLLTON LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1225
Mailing Address - Country:US
Mailing Address - Phone:314-804-3624
Mailing Address - Fax:314-804-5336
Practice Address - Street 1:331 N NEW BALLAS RD UNIT 410062
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-0062
Practice Address - Country:US
Practice Address - Phone:314-804-3624
Practice Address - Fax:314-804-5336
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496975814Medicaid