Provider Demographics
NPI:1821411067
Name:PEEBLES, GREGORY (AM, MA, PLPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:PEEBLES
Suffix:
Gender:M
Credentials:AM, MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 LINDELL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2948
Mailing Address - Country:US
Mailing Address - Phone:314-531-1155
Mailing Address - Fax:314-531-1170
Practice Address - Street 1:4236 LINDELL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2948
Practice Address - Country:US
Practice Address - Phone:314-531-1155
Practice Address - Fax:314-531-1170
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMHMedicaid