Provider Demographics
NPI:1215726591
Name:PETERS, NICOLE A (PLPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:PETERS
Suffix:
Gender:
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7651
Mailing Address - Country:US
Mailing Address - Phone:219-765-5651
Mailing Address - Fax:
Practice Address - Street 1:150 SAINT PETERS CENTRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1653
Practice Address - Country:US
Practice Address - Phone:636-466-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024049252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional