Doctor Name: | MRS. ERIN M PONIEWAZ |
NPI Number: | 1437318037 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 2007018361 |
Business Practice Address: | 1400 Us Hwy 61 Crystal City, MO - 63019 |
Business Phone Number: | 6369331205 |
Business Fax Number: | 6369331837 |
Mailing Address: | 1400 Us Hwy 61, CRYSTAL CITY |
State: | MO |
Postal Code: | 63019 |
Phone Number: | 6369331205 |
Fax Number: | 6369331837 |
NPI Enumeration Date: | 06/09/2008 |
NPI Last Update Date: | 06/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2007018361 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |