MEDICARE: JUSTINE LEA BROOKS FROELKER MED, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2006009165	MO

General Provider Information

NPI Number	:	1508019563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE LEA BROOKS FROELKER MED, LPC

Provider Business Mailing Address
First Line	:	4168 JUNIATA ST
Second Line	:	SUITE 1
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3931
Country	:	US
Telephone Number	:	314-283-6264
Fax Number	:

Provider Business Practice Location Address
First Line	:	4168 JUNIATA ST
Second Line	:	SUITE 1
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-3931
Country	:	US
Telephone Number	:	314-283-6264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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