Provider Demographics
NPI:1689933863
Name:PETRI JOKERST, MARGARET T (LPC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:T
Last Name:PETRI JOKERST
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:T
Other - Last Name:PETRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCPC
Mailing Address - Street 1:10805 SUNSET OFFICE DRIVE, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1027
Mailing Address - Country:US
Mailing Address - Phone:314-238-1213
Mailing Address - Fax:314-238-1250
Practice Address - Street 1:9530 WATSON INDUSTRIAL PARK
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1542
Practice Address - Country:US
Practice Address - Phone:314-963-8368
Practice Address - Fax:314-963-8935
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001166101YP2500X
MO001923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487791786Medicaid