St Louis Organization for Changing Men

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

TAX ID#: 12463256 Issued in MO

Legal business name

ST LOUIS ORGANIZATION FOR CHANGING MEN

Doing business as

d/b/a RAVEN

Practice address

4515 Olive St
Suite 200
Saint Louis, MO 63108-1814

Phone

(314) 645-2075

NPI assigned

Nov 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Barb Hiltz, MSW

Title

Executive Director

Phone

(314) 645-2075

Specialties & licenses 1

Addresses

Other names 1

• d/b/a RAVEN Doing business as

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194803114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 OLIVE ST",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081814",
            "telephone_number": "314-645-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 OLIVE ST",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081814",
            "telephone_number": "314-645-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS ORGANIZATION FOR CHANGING MEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HILTZ",
        "authorized_official_first_name": "BARB",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-645-2075",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "MO",
            "license": "TAX ID#: 12463256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a RAVEN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Voluntary or Charitable Agency in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Voluntary or Charitable Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.