Provider Demographics
NPI:1831370006
Name:TRUNK, CONNIE S (MED, LPC, NCC,NBCC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:S
Last Name:TRUNK
Suffix:
Gender:F
Credentials:MED, LPC, NCC,NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5494 BROWN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1100
Mailing Address - Country:US
Mailing Address - Phone:314-731-7667
Mailing Address - Fax:
Practice Address - Street 1:5494 BROWN RD
Practice Address - Street 2:SUITE 110 NEW BEGINNINGS CONNIE TRUNK , LPC,NCC
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63042-1100
Practice Address - Country:US
Practice Address - Phone:314-731-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11533239OtherCAQH ID