Provider Demographics
NPI:1053831834
Name:HENNING, ANASTASIA LEIGH (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:LEIGH
Last Name:HENNING
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:LEIGH
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:534 VISTA HILLS CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3605
Mailing Address - Country:US
Mailing Address - Phone:314-550-5149
Mailing Address - Fax:
Practice Address - Street 1:2646 HIGHWAY 109 STE 212
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1162
Practice Address - Country:US
Practice Address - Phone:314-550-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health