Healthcare Provider Details

I. General information

NPI: 1902475718
Provider Name (Legal Business Name): JULIA F COVILLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 FERN RIDGE PKWY STE 110
SAINT LOUIS MO
63141-4405
US

IV. Provider business mailing address

2306 SAINT ROBERT LN
SAINT CHARLES MO
63301-1448
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-8599
  • Fax:
Mailing address:
  • Phone: 662-609-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024024473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: