Healthcare Provider Details

I. General information

NPI: 1043881949
Provider Name (Legal Business Name): MARISA A GERKEN PL-MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WESTBURY DR
SAINT CHARLES MO
63301-2558
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-6476
  • Fax: 636-946-6479
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-946-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2020009142
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: