Provider Demographics
NPI:1316262314
Name:GREENWOOD, LAURA PEROUTKA (LPC, ATR)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PEROUTKA
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:PEROUTKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, ATR
Mailing Address - Street 1:425 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1833
Mailing Address - Country:US
Mailing Address - Phone:314-730-2780
Mailing Address - Fax:314-963-7703
Practice Address - Street 1:425 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-1833
Practice Address - Country:US
Practice Address - Phone:314-730-2780
Practice Address - Fax:314-963-7703
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5381101YP2500X
MO2016000468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional