Provider Demographics
NPI:1730695362
Name:CURATORS OF THE UNIVERSITY OF MISSOURI
Entity type:Organization
Organization Name:CURATORS OF THE UNIVERSITY OF MISSOURI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:LEVEQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:314-516-6275
Mailing Address - Street 1:12837 FLUSHING MEADOWS DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-516-6275
Mailing Address - Fax:314-516-5347
Practice Address - Street 1:12837 FLUSHING MEADOWS DRIVE
Practice Address - Street 2:SUTIE 220
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-516-4357
Practice Address - Fax:314-516-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty