| Imagine Peace | |
|
425 Marshall Ave Webster Groves MO 63119-1833 | |
| (314) 737-6848 | |
| Not Available |
| Full Name | Imagine Peace |
|---|---|
| Speciality | Social Worker |
| Location | 425 Marshall Ave, Webster Groves, Missouri |
| Authorized Official Name and Position | Kimberly Probst Warden (OWNER) |
| Authorized Official Contact | 3147376848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine Peace 425 Marshall Ave Webster Groves MO 63119-1833 Ph: (314) 737-6848 | Imagine Peace 425 Marshall Ave Webster Groves MO 63119-1833 Ph: (314) 737-6848 |
| NPI Number | 1558988931 |
|---|---|
| Provider Enumeration Date | 07/01/2020 |
| Last Update Date | 07/01/2020 |
| Certification Date | 07/01/2020 |
| Medicare PECOS PAC ID | 8921426081 |
|---|---|
| Medicare Enrollment ID | O20200922001821 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558988931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kimberly Probst Warden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922545847 PECOS PAC ID: 5294155800 Enrollment ID: I20201021001017 |
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