Individual
JOAN CASSILLY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
PERSONAL POTENTIALS, INC., 10000 WATSON RD #2L18, ST LOUIS, MO 63126
(314) 822-4727
(314) 822-0531
Mailing address
PERSONAL POTENTIALS, INC., 10000 WATSON RD #2L18, ST LOUIS, MO 63126
(314) 822-4727
(314) 822-0531
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
000296
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005794000
MBH NETWORK PROVIDER
—
01
—
064401
V/O NETWORK PROVIDER
—
01
—
111252
A/B NETWORK PROVIDER
—
01
—
185524
COMPSYCH NETWORK PROVIDER
—
05
—
493289102
—
MO
01
—
6122
BCBS NETWORK PROVIDER
—
01
—
6267853
UBH NETWORK PROVIDER
—
Enumeration date
08/29/2006
Last updated
09/03/2008
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