Healthcare Provider Details

I. General information

NPI: 1104257385
Provider Name (Legal Business Name): KAREN MISTY THORNTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S BRENTWOOD BLVD STE 503
SAINT LOUIS MO
63144
US

IV. Provider business mailing address

300 E 36TH ST
KANSAS CITY MO
64111-1410
US

V. Phone/Fax

Practice location:
  • Phone: 314-881-0350
  • Fax: 816-508-1757
Mailing address:
  • Phone: 816-508-1700
  • Fax: 816-508-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2016019476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: