Provider Demographics
NPI:1487718854
Name:CATHOLIC COMPREHENSIVE SERVICES FOR CHILDREN, CHILD CENTER-MARYGROVE
Entity type:Organization
Organization Name:CATHOLIC COMPREHENSIVE SERVICES FOR CHILDREN, CHILD CENTER-MARYGROVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-830-6222
Mailing Address - Street 1:2705 MULLANPHY LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-3727
Mailing Address - Country:US
Mailing Address - Phone:314-837-1702
Mailing Address - Fax:314-830-6263
Practice Address - Street 1:2705 MULLANPHY LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3727
Practice Address - Country:US
Practice Address - Phone:314-837-1702
Practice Address - Fax:314-830-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X
MO000045669322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health