Healthcare Provider Details

I. General information

NPI: 1295279487
Provider Name (Legal Business Name): KRISTI LYNN THERIOT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2721
US

IV. Provider business mailing address

752 ESTES PARK DR
SAINT PETERS MO
63376-2089
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-6811
  • Fax: 314-739-6825
Mailing address:
  • Phone: 636-734-4063
  • Fax: 314-739-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010008295
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: