Provider Demographics
NPI:1710217005
Name:JANSEN, TRINA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:MARIE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:MARIE
Other - Last Name:DELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4561 S COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-1554
Mailing Address - Country:US
Mailing Address - Phone:314-369-8721
Mailing Address - Fax:314-351-2940
Practice Address - Street 1:4561 S COMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1554
Practice Address - Country:US
Practice Address - Phone:314-369-8721
Practice Address - Fax:314-351-2940
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional