Provider Demographics
NPI:1861474280
Name:PROBUS-SCHAD, JULIE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:PROBUS-SCHAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17295 CHESTERFIELD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1423
Mailing Address - Country:US
Mailing Address - Phone:636-733-7527
Mailing Address - Fax:
Practice Address - Street 1:17295 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1423
Practice Address - Country:US
Practice Address - Phone:636-733-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0048161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000078732Medicare ID - Type Unspecified