Community & Long-Term Care Psychiatry LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

2015002634 Issued in MO

Legal business name

COMMUNITY & LONG-TERM CARE PSYCHIATRY LLC

Practice address

10004 Kennerly Rd
Ste 362B
Saint Louis, MO 63128-2141

Phone

(314) 849-0450

Fax

(314) 849-0159

NPI assigned

May 19, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Betty Jane Dickerman

Title

Billing Manager

Phone

(314) 849-0450

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Community and Long-Term Care Psychiatry LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Community and Long-Term Care Psychiatry LLC

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1699121475
  NPD tax ID

Practitioners 1

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

• Ernest Alexander Graypel, MD

  • Psychiatry Physician
  • St Louis, MO
  • NPI 1265723407
  NPD

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

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1528415536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "STE 362B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282141",
            "telephone_number": "314-849-0450",
            "fax_number": "314-849-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "STE 362B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282141",
            "telephone_number": "314-849-0450",
            "fax_number": "314-849-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY & LONG-TERM CARE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "DICKERMAN",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "314-849-0450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "MO",
            "license": "2015002634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265723407",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Behavior Analyst in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; 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.