Healthcare Provider Details

I. General information

NPI: 1003261777
Provider Name (Legal Business Name): STEPHANIE KEUNE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PARKWAY DRIVE BRIDGEWAY BEHAVIORAL HEALTH
SAINT PETERS MO
63376-6459
US

IV. Provider business mailing address

2120 PARKWAY DRIVE BRIDGEWAY BEHAVIORAL HEALTH
ST. PETERS MO
63376
US

V. Phone/Fax

Practice location:
  • Phone: 636-224-1163
  • Fax: 636-925-1443
Mailing address:
  • Phone: 636-224-1163
  • Fax: 636-925-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013043231
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: