Adrienne Romayne Petty, LPC
Individual provider Active NPI Professional Counselor · Black Jack, MO
NPI 1134735665 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1134735665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2017043874 (MO)
- Practice address
- 12100 Old Halls Ferry Rd
Black Jack, MO 63033-7112 - Phone
- (314) 441-6679
- NPI assigned
- Sep 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017043874 | MO | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 2017043874 | MO | Yes |
Addresses
Primary practice location
12100 Old Halls Ferry Rd
Black Jack, MO 63033-7112
Mailing address
4883 Bristol Rock Rd
Black Jack, MO 63033-7104
Phone (314) 441-6679
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Sanalake.com | Sana Lake Recovery Center, LLC |
Other providers in Black Jack, MO
- Moore Care Home Health Services
- Tamicka Nelson- Bobo
- Rochelle Deniece Patterson
- Ashley Payton
- Arial Lynnai Peterson
- Precious Palms Home Services LLC
- Amber Ranita Price
- Pure Hearts Homecare LLC
- Res Express Services LLC
- Royalty CDS Agency LLC
All providers in Black Jack, MO · Professional Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.