=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336552033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH LENAC JR. PSYCHOLOGIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2014
-----------------------------------------------------
Last Update Date | 06/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 N NEW BALLAS RD SUITE 280
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-6814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-995-7201
-----------------------------------------------------
Fax | 314-995-7032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 N NEW BALLAS RD SUITE 280
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-6814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-995-7201
-----------------------------------------------------
Fax | 314-995-7032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0011661
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 01759
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------