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General NPI Number Information
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NPI Number | 1811580970
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Entity Type | Individual
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Provider Name | CARLA JEANETTE POWDERLY LPC
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Gender | Female
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 5988 MID RIVERS MALL DR
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City | SAINT PETERS
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State | MO
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Zip | 63304-7119
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Country | US
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Telephone | 314-328-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 3521 EAGLES HILL RDG
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6483
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Country | US
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Telephone | 636-699-0459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2019009034
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License Number State | MO
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