Provider Demographics
NPI:1255319554
Name:SENNOTT, JOHN S III (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SENNOTT
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-634-5400
Mailing Address - Fax:573-636-2639
Practice Address - Street 1:1303 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1943
Practice Address - Country:US
Practice Address - Phone:573-634-5400
Practice Address - Fax:573-636-2639
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000160101YP2500X
MO0000911041C0700X
MO30036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493243505Medicaid
MO000078186Medicare PIN