Provider Demographics
NPI:1164636163
Name:VERSTRAETE, MARGARET MARY (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:VERSTRAETE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:MARY
Other - Last Name:VERSTRAETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:255 SPENCER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2494
Mailing Address - Country:US
Mailing Address - Phone:636-498-2273
Mailing Address - Fax:636-498-0390
Practice Address - Street 1:255 SPENCER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2494
Practice Address - Country:US
Practice Address - Phone:636-498-2273
Practice Address - Fax:636-498-0390
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004037116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional