Provider Demographics
NPI:1447734702
Name:DRATTLO, ATHENA (PLPC)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:DRATTLO
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1484
Mailing Address - Country:US
Mailing Address - Phone:636-223-0250
Mailing Address - Fax:
Practice Address - Street 1:764 WEBER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3317
Practice Address - Country:US
Practice Address - Phone:573-664-1326
Practice Address - Fax:573-664-1328
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO007171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional