Provider Demographics
NPI:1821416553
Name:MARASIGAN, JULIAN (PLPC)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:
Last Name:MARASIGAN
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MONARCH TRACE CT
Mailing Address - Street 2:APT 205
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4620
Mailing Address - Country:US
Mailing Address - Phone:314-472-3608
Mailing Address - Fax:
Practice Address - Street 1:10702 MANCHESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-1321
Practice Address - Country:US
Practice Address - Phone:314-529-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014008405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional