Imynd Connects, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

IMYND CONNECTS, LLC

Practice address

745 Craig Rd Ste 104
Creve Coeur, MO 63141-7122

Phone

(314) 606-1265

NPI assigned

Apr 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Elizabeth Stevenson Moore, MSW, LCSW

Title

Owner

Phone

(314) 606-1265

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1104446194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 CRAIG RD STE 104",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417122",
            "telephone_number": "314-606-1265",
            "fax_number": "314-202-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 CRAIG RD STE 104",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417122",
            "telephone_number": "314-606-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMYND CONNECTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "STEVENSON MOORE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-606-1265",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.