Provider Demographics
NPI:1790298198
Name:STUECKEN, JINA M (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:JINA
Middle Name:M
Last Name:STUECKEN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 KEATON CROSSING BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8223
Mailing Address - Country:US
Mailing Address - Phone:314-497-9657
Mailing Address - Fax:
Practice Address - Street 1:4132 KEATON CROSSING BLVD STE 204
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8223
Practice Address - Country:US
Practice Address - Phone:314-497-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health