Active NPI
Raymond C Tait, PHD
- Clinical Psychologist
- Saint Louis, MO
National Provider Identifier
1225002447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 01087
- Practice address
- 1221 S Grand
St Louis, MO 63104 - Phone
- (314) 268-5424
- Fax
- (314) 268-5736
- NPI assigned
- Feb 14, 2006
- Last updated
- Jan 9, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 01087 | MO | Primary |
Addresses
Primary practice location
1221 S Grand
St Louis, MO 63104
Mailing address
3691 Rutger Ave
Provider Enrollment
St Louis, MO 63110
Phone (314) 977-4440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01087 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Louis University | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199836800000",
"number": "1225002447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3691 RUTGER AVE",
"address_2": "PROVIDER ENROLLMENT",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-977-4440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 S GRAND",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63104",
"telephone_number": "314-268-5424",
"fax_number": "314-268-5736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAIT",
"first_name": "RAYMOND",
"middle_name": "C",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2008-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "01087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.