1689933863 NPI number — MS. MARGARET T PETRI JOKERST LPC, LCPC

Table of content: MS. MARGARET T PETRI JOKERST LPC, LCPC (NPI 1689933863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689933863 NPI number — MS. MARGARET T PETRI JOKERST LPC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRI JOKERST
Provider First Name:
MARGARET
Provider Middle Name:
T
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETRI
Provider Other First Name:
MARGARET
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689933863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10805 SUNSET OFFICE DRIVE, SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63127-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-238-1213
Provider Business Mailing Address Fax Number:
314-238-1250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9530 WATSON INDUSTRIAL PARK
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63126-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-963-8368
Provider Business Practice Location Address Fax Number:
314-963-8935
Provider Enumeration Date:
05/09/2012

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:  180.001166 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 001923 , 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)

  • Identifier: 1487791786 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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