Provider Demographics
NPI:1932575628
Name:SEIDEL COUNSELING LLC
Entity type:Organization
Organization Name:SEIDEL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:636-686-0706
Mailing Address - Street 1:111 PROSPECT AVE
Mailing Address - Street 2:SUITE 203J
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6052
Mailing Address - Country:US
Mailing Address - Phone:636-686-0706
Mailing Address - Fax:
Practice Address - Street 1:111 PROSPECT AVE
Practice Address - Street 2:SUITE 203J
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6052
Practice Address - Country:US
Practice Address - Phone:636-686-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014000741305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service