MEDICARE: JANIS STOCK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C5001240	MO

General Provider Information

NPI Number	:	1033315676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS STOCK LPC

Provider Business Mailing Address
First Line	:	3515 HIALEAH DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-7384
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 TOWNE DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-2339
Country	:	US
Telephone Number	:	573-474-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/09/2007

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Directions to “ JANIS STOCK LPC” Practice Location

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