Healthcare Provider Details

I. General information

NPI: 1235323015
Provider Name (Legal Business Name): CHRISTI FULWOOD L.P.C., N.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTI BRANDENSTEIN LPC, NCC

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

IV. Provider business mailing address

2625 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-9350
  • Fax:
Mailing address:
  • Phone: 314-776-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007008630
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1600
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: