Provider Demographics
NPI:1366503740
Name:CLERC, JERRY C (MED LPC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:C
Last Name:CLERC
Suffix:
Gender:M
Credentials:MED LPC
Other - Prefix:
Other - First Name:JEROME
Other - Middle Name:C
Other - Last Name:CLERC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED LPC
Mailing Address - Street 1:3631 TAMM
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109
Mailing Address - Country:US
Mailing Address - Phone:314-863-3588
Mailing Address - Fax:314-863-0074
Practice Address - Street 1:225 SO MERAMEC
Practice Address - Street 2:ST 506
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105
Practice Address - Country:US
Practice Address - Phone:314-863-3588
Practice Address - Fax:314-863-0074
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOANTHEM 1111OtherBCBS ANTHEM NUMBER