Provider Demographics
NPI:1114579422
Name:JUENGST, STACEY ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANNE
Last Name:JUENGST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3434
Mailing Address - Country:US
Mailing Address - Phone:636-362-4803
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWATER PT STE 401
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-442-2612
Practice Address - Fax:636-265-2905
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016001342101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional