Provider Demographics
NPI:1558621946
Name:JENNIFER SEBACHER LLC
Entity Type:Organization
Organization Name:JENNIFER SEBACHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:636-387-3851
Mailing Address - Street 1:209 E ELM ST STE 11
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2649
Mailing Address - Country:US
Mailing Address - Phone:636-387-3851
Mailing Address - Fax:636-441-3923
Practice Address - Street 1:21 BARTLEY ST
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2720
Practice Address - Country:US
Practice Address - Phone:636-387-3851
Practice Address - Fax:636-441-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0025151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396020244Medicaid