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NPI Code Detail

MEDICARE: MRS. GABRIELLE CHRISTINA KRUS-WHITESIDE MA, LPC

MEDICARE: MRS. GABRIELLE CHRISTINA KRUS-WHITESIDE MA, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2018002534MO

General Provider Information

NPI Number : 1033684923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GABRIELLE CHRISTINA KRUS-WHITESIDE MA, LPC
Provider Business Mailing Address
First Line : 1457 BALI CT
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63126-1607
Country : US
Telephone Number : 314-596-7046
Fax Number :
Provider Business Practice Location Address
First Line : 400 N 5TH ST STE 201
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-1808
Country : US
Telephone Number : 636-277-9890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2018
Last Update Date : 12/15/2023

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