Healthcare Provider Details

I. General information

NPI: 1750991410
Provider Name (Legal Business Name): GRETCHEN A NIETERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 05/04/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE STE 2600
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1700
  • Fax: 314-396-8266
Mailing address:
  • Phone: 314-286-1700
  • Fax: 314-396-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019006991
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: