Provider Demographics
NPI:1518604909
Name:SOUTH SIDE COUNSELING INC
Entity Type:Organization
Organization Name:SOUTH SIDE COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:424-789-3174
Mailing Address - Street 1:5106 HAMPTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3115
Mailing Address - Country:US
Mailing Address - Phone:314-474-5186
Mailing Address - Fax:
Practice Address - Street 1:5106 HAMPTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3115
Practice Address - Country:US
Practice Address - Phone:424-789-3174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health