Healthcare Provider Details

I. General information

NPI: 1265026231
Provider Name (Legal Business Name): MARIA KOMETER PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 LINDELL BLVD STE 102
SAINT LOUIS MO
63108-2948
US

IV. Provider business mailing address

420 S HIGH ST
BELLEVILLE IL
62220-2119
US

V. Phone/Fax

Practice location:
  • Phone: 314-246-9698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020001183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: