Healthcare Provider Details

I. General information

NPI: 1588586440
Provider Name (Legal Business Name): JULIE GARY PHD, MPH, CRPS, CCHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S TUCKER BLVD
SAINT LOUIS MO
63102-1152
US

IV. Provider business mailing address

116 BOBBIE DR
SWANSEA IL
62226-3020
US

V. Phone/Fax

Practice location:
  • Phone: 314-621-5848
  • Fax:
Mailing address:
  • Phone: 618-406-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: