ANNIE MALONE CHILDREN AND FAMILY SERVICE CENTER


Address: 5355 Page Avenue, St. Louis, MO 63112
Phone: 3145310120

ANNIE MALONE CHILDREN AND FAMILY SERVICE CENTER (NPI# 1942449194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1942449194
Entity Type Organization
Organization Name ANNIE MALONE CHILDREN AND FAMILY SERVICE CENTER
Practice Address 5355 Page Avenue
St. Louis
MO 63112
Mailing Address 2612 Annie Malone Drive
St. Louis
MO 63113
Practice Telephone 3145310120
Practice Fax Number 3145310125
Mailing Telephone 3145310120
Mailing Fax Number 3145310125
Enumeration Date 2009-02-11
Last Update Date 2020-02-05
Authorized Official Name CHANNEL GENISE THOMAS (DIRECTOR OF CLINICAL AND OUTPATIENT)
Authorized Official Telephone 3145651110
Authorized Official Credential M.ED. LPC TF-CBT
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 385H00000X Respite Care 001305902 MO Respite Care Facility
N 322D00000X Residential Treatment Facility, Emotionally Disturbed Children 002136058 MO Residential Treatment Facilities
N 251300000X Local Education Agency (LEA) SEO200902 MO Agencies
Y 261QM0855X Clinic/Center
Specialization: Adolescent and Children Mental Health
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
MO 1942449194 05
MO 506278209 05

Office Location

Street Address 5355 PAGE AVENUE
City ST. LOUIS
State MO
Zip Code 63112

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NPI Name Taxonomy Address Enumeration
1851932990 Bobbie J. Harrington Technician 5626 Julian Avenue, St. Louis, MO 63112 2019-09-30
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1326457177 Clare Marie Salley Speech-Language Pathologist 5673 Waterman Blvd, Unit 31, St Louis, MO 63112 2014-08-06
1386999324 Family Love Adult Health Care Center, LLC Clinic/Center 286 Debaliviere Avenue, St. Louis, MO 63112 2012-07-16
1003133893 William Richard Humphrey II Chiropractor 5615 Pershing, Suite 22, St. Louis, MO 63112 2010-05-03
1558688408 Courtney Lynne Luster Counselor 5647 Delmar Blvd Ste 226, Saint Louis, MO 63112 2010-04-30
1134446602 Donald Trevor Cross Psychologist #7 Beverly Place, St. Louis, MO 63112 2010-04-23
1649507328 Vikram Choudhary Prosthetist 6126 Washington Blvd, # 201, St. Louis, MO 63112 2009-11-17
1992930325 Kelly Brook Hogan Social Worker 5355 Delmar, Saint Louis, MO 63112 2009-05-29
1568626349 Dannie E Williams Family Medicine 5621 Delmar Blvd Ste 108, Saint Louis, MO 63112 2008-07-11
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Taxonomy Information

Taxonomy Code 261QM0855X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Adolescent and Children Mental Health

Taxonomy Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
Notes: [7/1/2003: new]

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NPI Name Taxonomy Address Enumeration
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1548895790 Ozark Trails Youth Services Clinic/Center 40840 Cr Rd 181-280, Willow Springs, MO 65793-6579 2020-03-09
1366076721 Midwest Psychological Services, LLC Clinic/Center 220 W Argonne Dr Ste B, Kirkwood, MO 63122-4237 2020-02-25
1851860209 Preferred Family Healthcare, Inc Clinic/Center 3300 S National Ave Ste 500, Springfield, MO 65807-7343 2018-11-15
1548759251 Stacey Juengst Counseling Services Clinic/Center 1000 Edgewater Point Drive, Suite 401, Lake Saint Louis, MO 63367-2954 2018-05-08
1982129722 Solid Ground Counseling Services, LLC Clinic/Center 2515 W Allen Dr, Springfield, MO 65810-1300 2017-08-12
1740714823 Storge LLC Clinic/Center 7114 Vernon Ave, University City, MO 63130-2301 2017-04-17
1437527314 Emotional Health Therapy Clinic/Center 7730 Carondelet Ave, Suite 307, Saint Louis, MO 63105-3314 2015-09-09
1114055076 Burrell, Inc. Clinic/Center 3301 Berrywood Dr Ste 101, Columbia, MO 65201-6517 2007-03-01
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Competitor

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City ST. LOUIS
Zip Code 63112

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Dataset Information

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.

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