Jerry Waggoner Lpc L.l.c.
NPI #1548546583 in Lake Saint Louis, Missouri
Provider Information
- NPI Number
- 1548546583
- Entity Type
- Organization
- Organization Name
- Jerry Waggoner Lpc L.l.c.
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Oct 21, 2011
- Last Updated
- Oct 21, 2011
Practice Location
- Address
- 1000 LAKE SAINT LOUIS BLVD STE 260
- City
- Lake Saint Louis
- State
- Missouri
- ZIP Code
- 63367-2924
- Phone
- (314) 994-9344
Authorized Official
- Name
- MR. JERRY WAGGONER, LPC
- Title
- SOLE MEMBER
- Phone
- (636) 633-1980
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
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