Provider Demographics
NPI:1376246009
Name:CARROTHERS PEROUTKA, CARA ANN (PLPC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANN
Last Name:CARROTHERS PEROUTKA
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SHOREWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2655
Mailing Address - Country:US
Mailing Address - Phone:314-276-7690
Mailing Address - Fax:
Practice Address - Street 1:301 SOVEREIGN CT STE 115
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4435
Practice Address - Country:US
Practice Address - Phone:636-234-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health