INDEPENDENCE CENTER (NPI# 1083054787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083054787 |
| Entity Type | Organization |
| Organization Name | INDEPENDENCE CENTER |
| Other Organization Name | MIDWEST PSYCHIATRY |
| Practice Address |
4219 Laclede Ave Saint Louis MO 63108-2814 |
| Mailing Address |
4245 Forest Park Ave Saint Louis MO 63108-2810 |
| Practice Telephone | 3148805415 |
| Practice Fax Number | 3148805468 |
| Mailing Telephone | 3148805415 |
| Mailing Fax Number | 3148805468 |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2013-06-27 |
| Authorized Official Name | MISS ANGELA D. GRIFFARD (CHIEF FINANCIAL OFFICER (CFO)) |
| Authorized Official Telephone | 3148805415 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 560003943 | 05 |
| Other Name | Type Code |
|---|---|
| Midwest Psychiatry | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760839260 | Independence Center | Clinic/Center | 4245 Forest Park Ave, Saint Louis, MO 63108-2810 | 2016-05-16 |
| 1619146420 | Independence Center | Community/Behavioral Health | 320 N Ash St, Waukegan, IL 60085-3985 | 2008-02-26 |
| 1699944413 | Independence Center | Case Management | 813 Indiana Ave, Waukegan, IL 60085-2612 | 2008-02-26 |
| 1881863603 | Independence Center | Case Management | 815 Indiana Ave, Waukegan, IL 60085-2612 | 2008-02-26 |
| 1235308057 | Independence Center | Case Management | 817 Indiana Ave, Waukegan, IL 60085-2612 | 2008-02-26 |
| 1427227230 | Independence Center | Case Management | 819 Indiana Ave, Waukegan, IL 60085-2612 | 2008-02-26 |
| 1336318153 | Independence Center | Case Management | 1730 Washington St, Waukegan, IL 60085-5102 | 2008-02-26 |
| 1427227248 | Independence Center | Case Management | 2835 Washington St, Waukegan, IL 60085-4839 | 2008-02-26 |
| 1972772788 | Independence Center | Case Management | 2839 Washington St, Waukegan, IL 60085-4839 | 2008-02-26 |
| 1558494286 | Independence Center | Community/Behavioral Health | 8675 Olive Blvd, Saint Louis, MO 63132-2503 | 2007-03-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | INDEPENDENCE CENTER INC | 2025 Washington St, Waukegan, IL 60085-5131 |
| Massachusetts Corporations | INDEPENDENCE CENTER NEWCO LLC | The Clinton Exchange, 4 Clinton Square, C/o The Pyramid Companies, Syracuse, NY 13202 |
| Street Address |
4219 LACLEDE AVE |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63108-2814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477697746 | Laura E. Romer | Clinical Nurse Specialist | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2007-02-19 |
| 1588919567 | Tamlyn Michelle Ashford | Social Worker | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2012-07-17 |
| 1689942278 | Stephanie Natasha Gipson | Licensed Practical Nurse | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2011-12-09 |
| 1164715306 | Barbara Lynn Devos-schoenig | Social Worker | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2011-05-20 |
| 1821307208 | Deborah L Griffin | Registered Nurse | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2010-10-01 |
| 1851600233 | Jacqueline Henderson | Registered Nurse | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2010-10-01 |
| 1508175977 | Janet Markham | Registered Nurse | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2010-10-01 |
| 1174668289 | Independence Center | Psychiatry & Neurology | 4219 Laclede Ave, Suite B, Saint Louis, MO 63108-2814 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346851474 | Nigel Austen Thomas Cook | Social Worker | 4050 West Pine Blvd. Apt. 4118, St. Louis, MO 63108 | 2020-08-12 |
| 1467070011 | C2n Diagnostics, LLC | Clinical Medical Laboratory | 20 South Sarah Street, Saint Louis, MO 63108 | 2020-07-10 |
| 1609414358 | Kaylee Breitenbucher | Occupational Therapist | 4444 Forest Park Avenue, Msc 8505-94-01, St. Louis, MO 63108 | 2019-12-12 |
| 1114419546 | Activangels Home Health | Home Health | 4625 Lindell Blvd Ste 304, Saint Louis, MO 63108 | 2018-06-01 |
| 1215427349 | Heart To Heart Consolidated Home Care Service LLC | Home Health | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108 | 2018-05-15 |
| 1447755905 | Erin Virginia Adams | Student in an Organized Health Care Education/Training Program | 4355 Maryland Ave Apt 116, Saint Louis, MO 63108 | 2018-03-27 |
| 1033621172 | Roots Healthcare and Homes | In Home Supportive Care | 4300 Enright Ave, St. Louis, MO 63108 | 2017-10-30 |
| 1336661719 | House of Destiny Adult Day Care LLC | Clinic/Center | 4507 Olive Street, St Louis, MO 63108 | 2017-07-07 |
| 1003338492 | Khin Min Thu | Social Worker | 4236 Lindell Blvd., Suite 200, St Louis, MO 63108 | 2017-07-07 |
| 1679093967 | Together We Can Home Healthcare Services LLC | Home Health | 4144 Lindell Blvd Suite 221, Saint Louis, MO 63108 | 2017-06-27 |
| Find all providers in zip 63108 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275193906 | New Day Psychiatric Services | Psychiatry & Neurology | 9904 Clayton Rd Ste 135, Saint Louis, MO 63124-1149 | 2019-06-14 |
| 1336607282 | Qsr Psychiatric Solutions LLC | Psychiatry & Neurology | 12855 N 40 Dr Ste 350, Saint Louis, MO 63141-8669 | 2019-03-11 |
| 1992127492 | St. Anthony's Physician Organization | Psychiatry & Neurology | 10020 Kennerly Rd Fl 2, Saint Louis, MO 63128-2106 | 2014-01-17 |
| 1942644349 | Tianyuan Yin Cornell | Psychiatry & Neurology | 10020 Kennerly Rd, Saint Louis, MO 63128-2106 | 2013-04-29 |
| 1881943223 | Jessica Christine Oetting Rosenkvist | Psychiatry & Neurology | Washington University Department of Psychiatry, Campus Box 8134, Saint Louis, MO 63110-1010 | 2012-08-30 |
| 1902111388 | Daniel Murray | Psychiatry & Neurology | 4907 W Pine Blvd, Apt 318, Saint Louis, MO 63108 | 2010-08-10 |
| 1467767913 | Marie Walker | Psychiatry & Neurology | Wash U School of Medicine, 660 S Euclid Ave, Department of Psychiatry, Saint Louis, MO 63110 | 2010-08-09 |
| 1871804914 | Alexander E Graypel | Psychiatry & Neurology | 10004 Kennerly Rd Ste 362b, Saint Louis, MO 63128-2178 | 2010-06-23 |
| 1295051548 | Enquan Gao | Psychiatry & Neurology | 815 Renee Ln, Saint Louis, MO 63141-7642 | 2010-04-12 |
| 1124342894 | John Henry Sweet | Psychiatry & Neurology | 4930 Pershing Pl, Saint Louis, MO 63108-1202 | 2010-03-24 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63108 |
Please comment or provide details below to improve the information on INDEPENDENCE CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.