Provider Demographics
NPI:1912238254
Name:LIEBMANN, JEANNINE LISA (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:LISA
Last Name:LIEBMANN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MISS
Other - First Name:JEANNINE
Other - Middle Name:
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 WALLOCH DR.
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025
Mailing Address - Country:US
Mailing Address - Phone:314-537-3548
Mailing Address - Fax:
Practice Address - Street 1:791 NEW BEGINNINGS DR.
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069
Practice Address - Country:US
Practice Address - Phone:314-537-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030086-LICENSED101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional