Healthcare Provider Details

I. General information

NPI: 1316348774
Provider Name (Legal Business Name): CHRISTINE VAN GESSEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12837 FLUSHING MEADOWS DR SUITE 220
SAINT LOUIS MO
63131-1824
US

IV. Provider business mailing address

12837 FLUSHING MEADOWS DR SUITE 220
SAINT LOUIS MO
63131-1824
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2014031014
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: