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General NPI Number Information
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NPI Number | 1558621946
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Entity Type | Organization
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Legal Business Name | JENNIFER SEBACHER LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 21 BARTLEY ST
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City | SAINT PETERS
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State | MO
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Zip | 63376-2720
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Country | US
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Telephone | 636-387-3851
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Fax | 636-441-3923
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Provider Business Mailing Address
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Address Line | 209 E ELM ST STE 11
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City | O FALLON
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State | MO
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Zip | 63366-2649
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Country | US
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Telephone | 636-387-3851
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Fax | 636-441-3923
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | JENNIFER L SEBACHER
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Credential | LCSW
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Telephone | 636-387-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002515
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License Number State | MO
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