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General NPI Number Information
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NPI Number | 1760939029
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Entity Type | Organization
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Legal Business Name | FROM THE INSIDE OUT COUNSELING
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Dates
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Enumeration Date | 09/04/2016
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Last Update Date | 09/04/2016
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Provider Practice Location Address
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Address Line | 203 BOYD ST
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City | DE SOTO
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State | MO
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Zip | 63020-1703
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Country | US
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Telephone | 636-249-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 203 BOYD ST
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City | DE SOTO
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State | MO
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Zip | 63020-1703
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Country | US
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Telephone | 636-249-9993
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED COUNSELOR
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Name | MRS. JANE S BRENNEKE
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Credential | MS, LPC
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Telephone | 636-249-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2014004873
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License Number State | MO
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