NPIMap

Organization Active NPI

Kezia E Coleman PSYD LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clayton, MO
National Provider Identifier
1427673367
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
KEZIA E COLEMAN PSYD LLC
Practice address
7777 Bonhomme Ave Ste 1800
Clayton, MO 63105-1931
Phone
(314) 472-3091
NPI assigned
Jun 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

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

Authorized official

Name
Dr. Kezia Jackson, PSYDNPI 1790233153
Title
Owner
Phone
(314) 472-3091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

7777 Bonhomme Ave Ste 1800
Clayton, MO 63105-1931

Mailing address

7711 Bonhomme Ave Ste 720
Clayton, MO 63105-1908
Phone (314) 472-3091

Other identifiers 3

IdentifierTypeStateIssuer
1346600061MedicaidMO
1790233153MedicaidMO
1992030027MedicaidMO

Other names 2

  • Healing Spaces Psychological Services LLC Doing business as
  • Kezia E Coleman PsyD LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

7711 Bonhomme Ave
Ste 720
Saint Louis, MO 63105
Phone (314) 472-3091

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1427673367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7711 BONHOMME AVE STE 720",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "631051908",
            "telephone_number": "314-472-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 BONHOMME AVE STE 1800",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "631051931",
            "telephone_number": "314-472-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEZIA E COLEMAN PSYD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-16",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KEZIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-472-3091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346600061",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790233153",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992030027",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healing Spaces Psychological Services LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kezia E Coleman PsyD LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clayton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.