Provider Demographics
NPI:1457807315
Name:PELIKAN, YVETTE KRISTINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:KRISTINE
Last Name:PELIKAN
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 1:320 GRAVOIS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4122
Mailing Address - Country:US
Mailing Address - Phone:314-706-1562
Mailing Address - Fax:
Practice Address - Street 1:2025 S BRENTWOOD BLVD SUITE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:949-696-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37226104100000X
MO2017026573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker