Doctor Name: | SHELLEY LOUISE JUNGEN |
NPI Number: | 1093071003 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 2009035450 |
Business Practice Address: | 1450 E 10th St Rolla, MO - 654013648 |
Business Phone Number: | 6366679590 |
Business Fax Number: | |
Mailing Address: | 1450 E 10th St, ROLLA |
State: | MO |
Postal Code: | 654013648 |
Phone Number: | 6366679590 |
Fax Number: | |
NPI Enumeration Date: | 04/03/2012 |
NPI Last Update Date: | 03/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2009035450 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |