Provider Demographics
NPI:1013342187
Name:PACE, THERESA MARIE (MS, PLPC)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:MARIE
Last Name:PACE
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BRIERTON LN
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1972
Mailing Address - Country:US
Mailing Address - Phone:636-931-0300
Mailing Address - Fax:636-933-3510
Practice Address - Street 1:115 BRIERTON LN
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1972
Practice Address - Country:US
Practice Address - Phone:636-931-0300
Practice Address - Fax:636-933-3510
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid