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General NPI Number Information
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NPI Number | 1629450580
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Entity Type | Organization
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Legal Business Name | PENELOPE J PRESTON COUNSELING
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 1161 FORTUNE BLVD STE 400
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City | O FALLON
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State | IL
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Zip | 62269-7385
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Country | US
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Telephone | 618-409-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 FORTUNE BLVD STE 400
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City | O FALLON
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State | IL
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Zip | 62269-7385
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Country | US
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Telephone | 618-409-6062
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PROFESSIONAL COUN
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Name | PENELOPE J PRESTON
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Credential | M.A., L.C.P.C.
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Telephone | 618-409-6062
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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 | 180.008861
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License Number State | IL
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