Doctor Name: | MR. ROGER J FOURNELLE |
NPI Number: | 1538138375 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MED LPC NCC NCP |
License Number: | 61290 |
Business Practice Address: | 3720 Hampton Ave Suite 207 Saint Louis, MO - 631091438 |
Business Phone Number: | 3145594209 |
Business Fax Number: | 3147529445 |
Mailing Address: | 3831 Bowen St, ST LOUIS |
State: | MO |
Postal Code: | 631163123 |
Phone Number: | 3147529445 |
Fax Number: | 3147529445 |
NPI Enumeration Date: | 03/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 61290 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |