Provider Demographics
NPI:1255009098
Name:MONIZ, JENNIFER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MONIZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 JUNIATA ST # A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4810
Mailing Address - Country:US
Mailing Address - Phone:314-337-6909
Mailing Address - Fax:
Practice Address - Street 1:3624 JUNIATA ST # A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-4810
Practice Address - Country:US
Practice Address - Phone:314-337-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018044273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health