Provider Demographics
NPI:1013571967
Name:FUHRMANN, JUSTINE
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:FUHRMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12166 OLD BIG BEND RD STE 204
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6836
Mailing Address - Country:US
Mailing Address - Phone:314-822-8888
Mailing Address - Fax:888-909-9204
Practice Address - Street 1:12166 OLD BIG BEND RD STE 204
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6836
Practice Address - Country:US
Practice Address - Phone:314-822-8888
Practice Address - Fax:888-909-9204
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009200A104100000X
MO20210159881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker