Provider Demographics
NPI:1538522594
Name:MOELLER, JORIE RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:JORIE
Middle Name:RENEE
Last Name:MOELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WATSON RD
Mailing Address - Street 2:SUITE G 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1528
Mailing Address - Country:US
Mailing Address - Phone:314-748-5682
Mailing Address - Fax:314-843-0552
Practice Address - Street 1:102 E SPRINGFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1818
Practice Address - Country:US
Practice Address - Phone:636-583-1800
Practice Address - Fax:636-583-0836
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140265431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical