Provider Demographics
NPI:1487994877
Name:ST. LOUIS BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ST. LOUIS BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:QASIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-344-7770
Mailing Address - Street 1:12255 DEPAUL DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-344-7770
Mailing Address - Fax:314-298-0556
Practice Address - Street 1:12255 DEPAUL DR
Practice Address - Street 2:SUITE 490
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-7770
Practice Address - Fax:314-298-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N442084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE88951Medicare UPIN