Organization · Type 2 NPI

Independence Center

Community/Behavioral Health Agency · St. Louis, MO

NPI number 1174668289 Active

Practice location

4245 Forest Park Ave
St. Louis, MO 63108-2810

Fax (314) 286-4542

Specialties and licenses

Taxonomy	Code	License
Psychiatry Physician	2084P0800X	None listed
Occupational Therapist	225X00000X	None listed
Community/Behavioral Health Agency Primary	251S00000X	None listed

Community/Behavioral Health Agency: A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day suppo…

6 other providers at this address

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NPI record

NPI: 1174668289
Entity type: Organization (Type 2)
Issued: Feb 20, 2007
Last updated: Mar 18, 2026
Status: Active

Other names

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Independence Center Health Group · doing business as
Independence Center · former legal business name

Authorized official

Mrs. Patricia Holmes
Executive Director
(314) 880-5415

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1174668289

Independence Center's National Provider Identifier is 1174668289, issued on Feb 20, 2007. The primary taxonomy on file is Community/Behavioral Health Agency (251S00000X), and the practice location is in St. Louis, MO. The record was last updated on Mar 18, 2026.