Provider Demographics
NPI:1356020481
Name:JANSEN, ANNETTE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:JANSEN
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 1:1054 WYNDGATE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4343
Mailing Address - Country:US
Mailing Address - Phone:636-299-3772
Mailing Address - Fax:
Practice Address - Street 1:1001 BOARDWALK SPRINGS PL STE 111
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4777
Practice Address - Country:US
Practice Address - Phone:636-299-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021014384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional