Provider Demographics
NPI:1669176129
Name:JP THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:JP THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PICKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCPC
Authorized Official - Phone:217-821-5232
Mailing Address - Street 1:7203 DARTMOUTH AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3007
Mailing Address - Country:US
Mailing Address - Phone:217-821-5232
Mailing Address - Fax:
Practice Address - Street 1:807 W HIGHWAY 50 STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1856
Practice Address - Country:US
Practice Address - Phone:217-821-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty