Carla Jeanette Powderly, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2019009034 Issued in MO

Practice address

5988 Mid Rivers Mall Dr
Saint Peters, MO 63304-7119

Phone

(314) 328-4136

NPI assigned

Feb 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1811580970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 EAGLES HILL RDG",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633036483",
            "telephone_number": "636-699-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5988 MID RIVERS MALL DR",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633047119",
            "telephone_number": "314-328-4136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWDERLY",
        "first_name": "CARLA",
        "middle_name": "JEANETTE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2019009034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelvin L. Pollard II, MD
• Sarah Pollock, OTR/L
• Lori Porten
• Chasity Porter
• Sydney Porter
• Gary Dean Powell
• Kristin Powell
• Powerback Rehabilitation LLC
• Practice Management Affiliates Consulting Inc
• Jennifer L Prater, PHARM.D

• Mental Health Counselor in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.