Healthcare Provider Details

I. General information

NPI: 1932889581
Provider Name (Legal Business Name): KRISTY B JOHNSON-HERRELL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12355 DEPAUL DRIVE SUITE 150
BRIDGETON MO
63044
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2023028450
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: