Healthcare Provider Details

I. General information

NPI: 1083783922
Provider Name (Legal Business Name): PETRA CHRISTINA SCHOLZ GOULD LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 COUNTY RD. 3610
SAINT JAMES MO
65559
US

IV. Provider business mailing address

104 HILLCREST CT
SAINT ROBERT MO
65584-3275
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-3251
  • Fax:
Mailing address:
  • Phone: 573-528-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007007906
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: