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General NPI Number Information
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NPI Number | 1215123534
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Entity Type | Organization
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Legal Business Name | SOJOURNER COUNSELING
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 13422 CLAYTON RD SUITE 219
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1008
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Country | US
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Telephone | 314-579-9766
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Fax | 314-579-9795
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Provider Business Mailing Address
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Address Line | 13422 CLAYTON RD SUITE 219
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1008
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Country | US
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Telephone | 314-579-9766
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Fax | 314-579-9795
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Authorized Official
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Title or Position | LPC/OWNER
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Name | LESLIE JARVIS
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Credential | M.A.
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Telephone | 314-579-9766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002396
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License Number State | MO
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