Provider Demographics
NPI:1336552033
Name:LENAC, JOSEPH JR (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LENAC
Suffix:JR
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6814
Mailing Address - Country:US
Mailing Address - Phone:314-995-7201
Mailing Address - Fax:314-995-7032
Practice Address - Street 1:425 N NEW BALLAS RD
Practice Address - Street 2:SUITE 280
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6814
Practice Address - Country:US
Practice Address - Phone:314-995-7201
Practice Address - Fax:314-995-7032
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011661101YP2500X
MO01759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional