Healthcare Provider Details

I. General information

NPI: 1548759251
Provider Name (Legal Business Name): STACEY JUENGST COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDGEWATER POINT DRIVE SUITE 401
LAKE SAINT LOUIS MO
63367-2954
US

IV. Provider business mailing address

1369 SUNBURST DR
O FALLON MO
63366-3434
US

V. Phone/Fax

Practice location:
  • Phone: 636-362-4803
  • Fax: 636-265-2905
Mailing address:
  • Phone: 636-734-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2016001342
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2016001342
License Number StateMO

VIII. Authorized Official

Name: STACEY JUENGST
Title or Position: COUNSELOR
Credential: MA, LPC
Phone: 636-734-9112