Provider Demographics
NPI:1336220524
Name:PERSONAL POTENTIALS, INC.
Entity Type:Organization
Organization Name:PERSONAL POTENTIALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:CASSILLY
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:314-822-4727
Mailing Address - Street 1:10000 WATSON RD
Mailing Address - Street 2:STE. # 2L18
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-822-4727
Mailing Address - Fax:314-822-0531
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:STE. # 2L18
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-822-4727
Practice Address - Fax:314-822-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty