Provider Demographics
NPI:1891209177
Name:DE JONG, LINDSEY (LPC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:DE JONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 ALAMO AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3151
Mailing Address - Country:US
Mailing Address - Phone:239-357-7537
Mailing Address - Fax:
Practice Address - Street 1:478 COVENANT LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8629
Practice Address - Country:US
Practice Address - Phone:314-717-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013004021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health