Provider Demographics
NPI:1760857791
Name:GANT, JULIE ANN (ATR-BC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:GANT
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2328
Mailing Address - Country:US
Mailing Address - Phone:314-548-9270
Mailing Address - Fax:
Practice Address - Street 1:2510 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2328
Practice Address - Country:US
Practice Address - Phone:314-548-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038681101YM0800X
MO07-210221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health