Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2013043231 | MO |
NPI | 1003261777 |
---|---|
Provider Name | Stephanie Keune |
First Address | St. Peters, MO 63376 |
Second Address | Saint Peters, MO 63376-6459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 29/04/2016 |