Provider Demographics
NPI:1215470398
Name:KUENNEKE, SCOTT (MS, LPC, BCN)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KUENNEKE
Suffix:
Gender:M
Credentials:MS, LPC, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 POINT CHEROKEE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-4918
Mailing Address - Country:US
Mailing Address - Phone:314-749-0912
Mailing Address - Fax:
Practice Address - Street 1:14 POINT CHEROKEE CIR
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-4918
Practice Address - Country:US
Practice Address - Phone:314-749-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014032303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health