Healthcare Provider Details

I. General information

NPI: 1942635230
Provider Name (Legal Business Name): JESSICA COULTER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-4903
US

IV. Provider business mailing address

7520 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-4903
US

V. Phone/Fax

Practice location:
  • Phone: 314-222-4465
  • Fax:
Mailing address:
  • Phone: 314-222-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY13230
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2015042888
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: