Provider Demographics
NPI:1174921084
Name:PFLASTERER, CAITLIN R (MED, LCPC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:R
Last Name:PFLASTERER
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EAGLE CTR STE B-1
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1946
Mailing Address - Country:US
Mailing Address - Phone:618-577-0660
Mailing Address - Fax:
Practice Address - Street 1:7 EAGLE CTR STE B-1
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1946
Practice Address - Country:US
Practice Address - Phone:618-577-0660
Practice Address - Fax:618-726-2043
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011172101YP2500X, 101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional