Provider Demographics
NPI:1548759251
Name:STACEY JUENGST COUNSELING SERVICES
Entity Type:Organization
Organization Name:STACEY JUENGST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUENGST
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:636-734-9112
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:636-734-9112
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWATER POINT DRIVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-362-4803
Practice Address - Fax:636-265-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016001342261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health