Organization
SPRING GROVE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY KAYE WIEBERG LPC, LCSW (OWNER/DIRECTOR)
(573) 635-8299
Entity
Organization
Contact information
Practice address
211 A OSCAR DRIVE, JEFFERSON CITY, MO 65101-5167
(573) 635-8299
(573) 635-4629
Mailing address
211 A OSCAR DRIVE, JEFFERSON CITY, MO 65101-5167
(573) 635-8299
(573) 635-4629
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001621
MO
104100000X
Social Worker
002100
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493361109
—
MO
Enumeration date
10/29/2012
Last updated
10/29/2012
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