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General NPI Number Information
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NPI Number | 1891209177
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Entity Type | Individual
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Provider Name | LINDSEY DE JONG LPC
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Gender | Female
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Dates
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Enumeration Date | 11/26/2017
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Last Update Date | 11/26/2017
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Provider Practice Location Address
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Address Line | 478 COVENANT LN
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8629
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Country | US
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Telephone | 314-717-1265
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Fax |
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Provider Business Mailing Address
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Address Line | 6436 ALAMO AVE
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City | CLAYTON
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State | MO
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Zip | 63105-3151
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Country | US
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Telephone | 239-357-7537
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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 | 2013004021
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License Number State | MO
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