GREAT CIRCLE- EDGEWOOD CHILDREN'S CENTER (NPI# 1225388465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225388465 |
| Entity Type | Organization |
| Organization Name | GREAT CIRCLE- EDGEWOOD CHILDREN'S CENTER |
| Practice Address |
330 N Gore Ave Saint Louis MO 63119-1600 |
| Practice Telephone | 3149194750 |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2013-01-16 |
| Authorized Official Name | MR. CHRISTOPHER NOLL (THERAPIST) |
| Authorized Official Telephone | 3149194750 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 2012028396 | MO | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 130101100450083 | 05 |
| Street Address |
330 N GORE AVE |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63119-1600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750486387 | Joseph Norbert Beck | Social Worker | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2006-09-14 |
| 1720689326 | Sydney Tramaine Washington | Counselor | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2020-11-02 |
| 1083228795 | Aquila Rives | Counselor | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2020-09-01 |
| 1902417108 | Michael Patrick Meehan | Psychologist | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2020-08-11 |
| 1255963211 | Ruth Marie Caputo | Speech-Language Pathologist | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2020-02-07 |
| 1215577382 | Brooke Blythe | Counselor | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2020-01-07 |
| 1679112973 | Rachel Ruth Kloppe | Counselor | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2020-01-03 |
| 1932745924 | Marissa Joy Mcvicar | Behavioral Analyst | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2019-11-25 |
| 1538705702 | Patricia Fleischmann | Behavioral Analyst | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2019-11-22 |
| 1588214274 | Michelle Moore | Counselor | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2019-09-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114525631 | Kaylen A Howard | Specialist/Technologist | No, No, MO 63119 | 2020-10-16 |
| 1053887612 | St. Gianna Pediatrics, LLC | Pediatrics | 7387 Watson Road, Shrewsbury, MO 63119 | 2018-10-22 |
| 1982140265 | Forefront Dermatology, S.c. | Dermatology | 8567 Watson Rd, Webster Groves, MO 63119 | 2017-01-11 |
| 1407308018 | Tyler Clark | Student in an Organized Health Care Education/Training Program | 7785 Keswick Pl, Saint Louis, MO 63119 | 2016-10-30 |
| 1396109880 | Ritesh Gandhi | Family Medicine | 7345 Watson Rd Ste 203, Saint Louis, MO 63119 | 2016-04-11 |
| 1568834489 | Antonio Robinson | Counselor | 330 N. Gore, Great Circle, Saint Louis, MO 63119 | 2015-10-30 |
| 1922484039 | Odessa Baker X | Dietary Manager | 525 N. Laclede Station Road, St. Louis, MO 63119 | 2015-07-31 |
| 1194114694 | Laura Maher | Social Worker | 201 W. Lockwood Ave, Suite 201, St. Louis, MO 63119 | 2015-01-21 |
| 1427314046 | Dick (richard) Ralph Brummett | Family Medicine | 711 S Laclede Sta Rd, # 2111, St Louis, MO 63119 | 2012-04-09 |
| 1972872935 | Dolliene A. Raabe | Social Worker | 8050 Watson Road, Suite 201, St. Louis, MO 63119 | 2011-12-21 |
| Find all providers in zip 63119 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659558054 | General Assembly of The Christian Church Disciples of Christ St. Louis | Residential Treatment Facility, Emotionally Disturbed Children | 3033 N Euclid Ave, Saint Louis, MO 63115-1632 | 2008-01-28 |
| 1093881252 | Good Shepherd Children and Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 1340 Partridge Ave, Saint Louis, MO 63130-1943 | 2006-11-28 |
| 1790879617 | Presbyterian Children's Services | Residential Treatment Facility, Emotionally Disturbed Children | 1353 N Warson Rd, Saint Louis, MO 63132-1807 | 2006-10-03 |
| 1679578413 | Child Center of Our Lady | Residential Treatment Facility, Emotionally Disturbed Children | 7900 Natural Bridge Rd, Saint Louis, MO 63121-4628 | 2005-06-17 |
| 1578098489 | St. Vincent Home for Children | Residential Treatment Facility, Emotionally Disturbed Children | 7401 Florissant Rd, Saint Louis, MO 63121-4835 | 2017-04-28 |
| 1801109343 | Children's Foundation of Mid America | Residential Treatment Facility, Emotionally Disturbed Children | 1353 N Warson Rd, Saint Louis, MO 63132-1807 | 2010-07-26 |
| 1467781393 | Covenant House Missouri | Residential Treatment Facility, Emotionally Disturbed Children | 2727 N Kingshighway Blvd, Saint Louis, MO 63113-1006 | 2009-12-24 |
| 1780846451 | Susie Dietz Mcgaughey | Residential Treatment Facility, Emotionally Disturbed Children | 330 N Gore Ave, Saint Louis, MO 63119-1600 | 2008-06-25 |
| 1104093681 | German St. Vincent Orphan Association | Residential Treatment Facility, Emotionally Disturbed Children | 7401 Florissant Rd, Saint Louis, MO 63121-4835 | 2008-05-13 |
| 1356538243 | Beth A Reese | Residential Treatment Facility, Emotionally Disturbed Children | 8240 Saint Charles Rock Rd, Saint Louis, MO 63114-4508 | 2007-09-25 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63119 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.