Provider Demographics
NPI:1992280762
Name:NISSENBAUM, ARTHUR H (LPC)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:H
Last Name:NISSENBAUM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3126
Mailing Address - Country:US
Mailing Address - Phone:314-580-0454
Mailing Address - Fax:314-333-4153
Practice Address - Street 1:4106 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3126
Practice Address - Country:US
Practice Address - Phone:314-580-0454
Practice Address - Fax:314-333-4153
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional