Provider Demographics
NPI:1609470541
Name:BERTEL, JULIE M
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BERTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 TOWN SQUARE AVE STE 104-1243
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7197
Mailing Address - Country:US
Mailing Address - Phone:314-200-5548
Mailing Address - Fax:
Practice Address - Street 1:7827 TOWN SQUARE AVE STE 104-1243
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7197
Practice Address - Country:US
Practice Address - Phone:314-200-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TS0200X
MO2021042139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool