MEDICARE: STACIE L GROJEAN 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	101YM0800X	Mental Health Counselor	2019002274	MO

General Provider Information

NPI Number	:	1699450726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE L GROJEAN LPC

Provider Business Mailing Address
First Line	:	437 CHARLESTOWNE PLACE DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4916
Country	:	US
Telephone Number	:	636-279-0912
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 CHARLESTOWNE PLACE DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4916
Country	:	US
Telephone Number	:	636-279-0912
Fax Number	:

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

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	07/03/2023

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