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General NPI Number Information
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NPI Number | 1932575628
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Entity Type | Organization
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Legal Business Name | SEIDEL COUNSELING LLC
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 111 PROSPECT AVE SUITE 203J
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City | KIRKWOOD
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State | MO
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Zip | 63122-6052
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Country | US
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Telephone | 636-686-0706
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Fax |
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Provider Business Mailing Address
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Address Line | 111 PROSPECT AVE SUITE 203J
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City | KIRKWOOD
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State | MO
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Zip | 63122-6052
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Country | US
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Telephone | 636-686-0706
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MS. JODI E. SEIDEL
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Credential | MA, LPC
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Telephone | 636-686-0706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2014000741
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License Number State | MO
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