HEALING SPACES PSYCHOLOGICAL SERVICES (NPI# 1427673367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427673367 |
| Entity Type | Organization |
| Organization Name | HEALING SPACES PSYCHOLOGICAL SERVICES |
| Practice Address |
7777 Bonhomme Ave Ste 1800 Clayton MO 63105-1931 |
| Practice Telephone | 3144723091 |
| Mailing Telephone | 3144723091 |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |
| Authorized Official Name | DR. KEZIA JACKSON (OWNER) |
| Authorized Official Telephone | 3144723091 |
| Authorized Official Credential | PSYD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1790233153 | 05 |
| Other Name | Type Code |
|---|---|
| Kezia E Coleman PsyD LLC | Former Legal Business Name - Organization |
| Street Address |
7777 BONHOMME AVE STE 1800 |
| City | CLAYTON |
| State | MO |
| Zip Code | 63105-1931 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306118435 | Franchon Barnes | Registered Nurse | 7777 Bonhomme Ave Ste 1800, Clayton, MO 63105 | 2012-02-06 |
| 1508464413 | Bethany Deichmann | Behavior Technician | 7777 Bonhomme Ave Ste 1800, Clayton, MO 63105-1931 | 2020-10-13 |
| 1962963488 | Hillary Tinsley | Home Health | 7777 Bonhomme Ave Ste 1800, Clayton, MO 63105-1931 | 2019-03-27 |
| 1790233153 | Kezia Jackson | Psychologist | 7777 Bonhomme Ave Ste 1800, Clayton, MO 63105-1931 | 2016-09-14 |
| 1639535081 | A Nurses Touch In Home Health, LLC | In Home Supportive Care | 7777 Bonhomme Ave Ste 1800, Clayton, MO 63105-1931 | 2016-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861016545 | Amy Piontek | Registered Nurse | Habif Health and Wellness Center, 6643 Shepley Drive, St. Louis, MO 63105 | 2020-05-29 |
| 1427520634 | Justin Kelly | Chiropractor | 8011 Maryland Avenue, St. Louis, MO 63105 | 2018-12-28 |
| 1720576663 | St. Louis Center for Cognitive Health, LLC | Clinic/Center | 7711 Bonhomme Ave Ste 350, Clayton, MO 63105 | 2018-04-26 |
| 1457849317 | A Storied Life Counseling LLC | Social Worker | 8000 Bonhomme Ave Ste 321, Clayton, MO 63105 | 2018-04-26 |
| 1669984142 | Peter Bogart | Counselor | 7710 Carondelet, Suite #204, Saint Louis, MO 63105 | 2017-10-24 |
| 1356891162 | Medical West Respiratory Pharmacy, LLC | Pharmacy | 440 South Brentwood Blvd, Clayton, MO 63105 | 2016-10-05 |
| 1710435565 | James Breihan | Occupational Therapist | 401 Corporate Park Drive, Clayton, MO 63105 | 2016-09-21 |
| 1730566928 | Frank Theus | Counselor | 7710 Carondelet Ave Ste 220, Saint Louis, MO 63105 | 2015-04-27 |
| 1962895896 | John B Martin | Obstetrics & Gynecology | 312 N. Meramec #300, St. Louis, MO 63105 | 2015-03-17 |
| 1861814261 | Jesse Marie Civello | Physical Therapist | 222 S Meramec Avenue, Suite 100, Clayton, MO 63105 | 2014-01-20 |
| Find all providers in zip 63105 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720576663 | St. Louis Center for Cognitive Health, LLC | Clinic/Center | 7711 Bonhomme Ave Ste 350, Clayton, MO 63105 | 2018-04-26 |
| 1376033985 | Logic Psychology LLC | Clinic/Center | 8008 Carondelet Ave Ste 308, Clayton, MO 63105-1724 | 2018-05-18 |
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| 1891329322 | Individual Marriage and Family Enrichment LLC | Clinic/Center | 601 W Nifong Blvd Ste 1e, Columbia, MO 65203-6804 | 2020-02-24 |
| 1861024754 | Chrysalis Wellness LLC | Clinic/Center | 3863 S Campbell Ave Ste A, Springfield, MO 65807-5339 | 2020-02-07 |
| 1275178451 | Awaken360, Inc. | Clinic/Center | 829 W Atlantic St, Springfield, MO 65803-1517 | 2019-11-12 |
| 1053953422 | Kirwood Medication Assisted Treatments | Clinic/Center | 111 Prospect Ave Ste 201, Kirkwood, MO 63122-6052 | 2019-10-17 |
| Find all providers with the same taxonomy | ||||
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| 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.