Healthcare Provider Details

I. General information

NPI: 1184072712
Provider Name (Legal Business Name): CATHERINE ANN KLUGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 GREAT HILL DR
BALLWIN MO
63021-6260
US

IV. Provider business mailing address

548 GREAT HILL DR
BALLWIN MO
63021-6260
US

V. Phone/Fax

Practice location:
  • Phone: 314-629-8512
  • Fax:
Mailing address:
  • Phone: 314-629-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2001005760
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001005760
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: