Individual provider Active NPI

Kathy Ann Poelker, LPC

  • Counselor
  • St Louis, MO
National Provider Identifier
1114089406
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
000602 Issued in MO
Practice address
1515 N Warson
Ste 119
St Louis, MO 63123-1108
Phone
(314) 280-8910
Fax
(636) 939-0057
NPI assigned
Dec 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 000602 MO Primary

Addresses

Primary practice location

1515 N Warson
Ste 119
St Louis, MO 63123-1108

Mailing address

43 Millstone
St Charles, MO 63303-2914
Phone (314) 280-8910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
000602MOMDCounselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114089406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 MILLSTONE",
            "city": "ST CHARLES",
            "state": "MO",
            "postal_code": "633032914",
            "telephone_number": "314-280-8910",
            "fax_number": "636-939-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N WARSON",
            "address_2": "STE 119",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631231108",
            "telephone_number": "314-280-8910",
            "fax_number": "636-939-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POELKER",
        "first_name": "KATHY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "000602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.