Provider Demographics
NPI:1174380992
Name:NICHOLSON-BEHNKEN, VERNON J (PLPC)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:J
Last Name:NICHOLSON-BEHNKEN
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:BEHNKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PLPC
Mailing Address - Street 1:1603 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2753
Mailing Address - Country:US
Mailing Address - Phone:618-975-6000
Mailing Address - Fax:
Practice Address - Street 1:2081 COLLIER CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-255-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024007531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional