Provider Demographics
NPI:1083783922
Name:SCHOLZ GOULD, PETRA CHRISTINA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:CHRISTINA
Last Name:SCHOLZ GOULD
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HILLCREST CT
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3275
Mailing Address - Country:US
Mailing Address - Phone:573-528-5495
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY RD. 3610
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007007906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional