Healthcare Provider Details

I. General information

NPI: 1215577382
Provider Name (Legal Business Name): BROOKE BLYTHE KERBEL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE BLYTHE

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12810 TESSON FERRY RD STE 103
SAINT LOUIS MO
63128-2913
US

IV. Provider business mailing address

144 SIGSBEE AVE
SAINT LOUIS MO
63125-3711
US

V. Phone/Fax

Practice location:
  • Phone: 314-650-9537
  • Fax:
Mailing address:
  • Phone: 636-432-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2019047962
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019047962
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: