Healthcare Provider Details

I. General information

NPI: 1033606769
Provider Name (Legal Business Name): CHRISTINA MARIE CRAIN MS LPCLMHC NCC CCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHELE DR
SAINT CHARLES MO
63304
US

IV. Provider business mailing address

501 CHELE DR
SAINT CHARLES MO
63304-5516
US

V. Phone/Fax

Practice location:
  • Phone: 138-586-4652
  • Fax:
Mailing address:
  • Phone: 138-586-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13547
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018036210
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: