Individual
MR. ROGER J FOURNELLE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MED LPC NCC NCP
Contact information
Practice address
3720 HAMPTON AVE, SUITE 207, SAINT LOUIS, MO 63109-1438
(314) 559-4209
(314) 752-9445
Mailing address
3831 BOWEN ST, ST LOUIS, MO 63116-3123
(314) 752-9445
(314) 752-9445
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
61290
—
101YP2500X
Professional Counselor
2000152363
MO
103T00000X
Psychologist
01194
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
179068
BLUE CROSS BLUE SHIELD
MO
01
—
7811255
AETNA
—
Enumeration date
03/15/2006
Last updated
09/11/2025
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