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General NPI Number Information
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NPI Number | 1588993992
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Entity Type | Individual
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Provider Name | DIANE MENKE PENCE LMHC, LPC
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Gender | Female
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 2536 S OLD HIGHWAY 94 SUITE 234
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5612
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Country | US
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Telephone | 636-896-5842
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 PINE BLUFF DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-8785
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Country | US
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Telephone | 217-549-9292
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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 | 39002125
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC.0012588
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2016031492
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License Number State | MO
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