Healthcare Provider Details

I. General information

NPI: 1932824232
Provider Name (Legal Business Name): CRYSTAL BARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7012 HEEGE RD APT 108
SAINT LOUIS MO
63123-2353
US

IV. Provider business mailing address

7012 HEEGE RD APT 108
SAINT LOUIS MO
63123-2353
US

V. Phone/Fax

Practice location:
  • Phone: 314-255-7569
  • Fax:
Mailing address:
  • Phone: 314-255-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: