Provider Demographics
NPI:1891158812
Name:PRESTON, JANZA LEE
Entity Type:Individual
Prefix:MS
First Name:JANZA
Middle Name:LEE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-0701
Mailing Address - Country:US
Mailing Address - Phone:636-542-1024
Mailing Address - Fax:
Practice Address - Street 1:225 SOUTH MERAMEC
Practice Address - Street 2:432T
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3597
Practice Address - Country:US
Practice Address - Phone:636-542-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013044758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional