Unknown Individual – Clinical Child & Adolescent Psychologist, NPI 1902904410

Unknown Individual is a healthcare provider. based in Saint louis, Missouri. specializing in Clinical Child & Adolescent Psychologist. They hold a License No. 01574 (MO). The NPI Number for Unknown Individual is 1902904410

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1902904410
Phone
(314) 965-2533
Address
10777 SUNSET OFFICE DR
Deactivation Date
8 November 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 10777, Sunset Office Drive, Sunset Hills Office Park, Sunset Hills, Saint Louis County, Missouri, 63127, United States

    SUITE 220

    SAINT LOUIS, MO 631271019

    Phone: (314) 965-2533

    Fax: (931) 496-5471

    Type: Location

  • 1009, Etherton Drive, Elmont Park, Crestwood, Saint Louis County, Missouri, 63126, United States

    SAINT LOUIS, MO 631261108

    Phone: (314) 963-0659

    Fax: (314) 965-4711

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63127)

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Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1902904410 is assigned to Unknown Individual under the national enumeration system.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Clinical Child & Adolescent Psychologist. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Saint Louis, Missouri for Unknown Individual; download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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