1164636163 NPI number — MRS. MARGARET MARY VERSTRAETE M.ED, LPC

Table of content: MRS. MARGARET MARY VERSTRAETE M.ED, LPC (NPI 1164636163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164636163 NPI number — MRS. MARGARET MARY VERSTRAETE M.ED, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERSTRAETE
Provider First Name:
MARGARET
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERSTRAETE
Provider Other First Name:
MEG
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164636163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 SPENCER RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-498-2273
Provider Business Mailing Address Fax Number:
636-498-0390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 SPENCER RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-2494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-498-2273
Provider Business Practice Location Address Fax Number:
636-498-0390
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2004037116 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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