Healthcare Provider Details

I. General information

NPI: 1619209657
Provider Name (Legal Business Name): LINDA DENISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 CROSSWINDS CT
WENTZVILLE MO
63385-4836
US

IV. Provider business mailing address

1032 CROSSWINDS CT
WENTZVILLE MO
63385-4836
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-8000
  • Fax: 363-332-3045
Mailing address:
  • Phone: 636-332-8000
  • Fax: 363-332-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004036877
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: