Healthcare Provider Details

I. General information

NPI: 1922476217
Provider Name (Legal Business Name): BRYAN CURTIS KOHRING LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 WEBER RD
SAINT LOUIS MO
63123-5722
US

IV. Provider business mailing address

12110 CLAYTON RD
SAINT LOUIS MO
63131-2516
US

V. Phone/Fax

Practice location:
  • Phone: 314-550-8858
  • Fax:
Mailing address:
  • Phone: 314-989-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2011011824
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: