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General NPI Number Information
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NPI Number | 1215470398
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Entity Type | Individual
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Provider Name | SCOTT KUENNEKE MS, LPC, BCN
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Gender | Male
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 14 POINT CHEROKEE CIR
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City | LAKE OZARK
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State | MO
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Zip | 65049-4918
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Country | US
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Telephone | 314-749-0912
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Fax |
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Provider Business Mailing Address
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Address Line | 14 POINT CHEROKEE CIR
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City | LAKE OZARK
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State | MO
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Zip | 65049-4918
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Country | US
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Telephone | 314-749-0912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2014032303
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License Number State | MO
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