Healthcare Provider Details

I. General information

NPI: 1922304187
Provider Name (Legal Business Name): JULIA L PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 LINDELL BLVD
SAINT LOUIS MO
63108-2948
US

IV. Provider business mailing address

8141 GANNON AVE
SAINT LOUIS MO
63130-3732
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-3282
  • Fax:
Mailing address:
  • Phone: 646-808-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2012024493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: