Healthcare Provider Details

I. General information

NPI: 1033978978
Provider Name (Legal Business Name): CHRISTINA SEMENCHUK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 GLENDALE RD
COUNTRY CLUB MO
64505-1028
US

IV. Provider business mailing address

3905 E HILLS DR
SAINT JOSEPH MO
64503-2238
US

V. Phone/Fax

Practice location:
  • Phone: 505-240-2292
  • Fax:
Mailing address:
  • Phone: 505-240-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026036752
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: