Healthcare Provider Details

I. General information

NPI: 1184821423
Provider Name (Legal Business Name): ERIN KARANDISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EXECUTIVE PARKWAY DR STE 106
SAINT LOUIS MO
63141-6369
US

IV. Provider business mailing address

10 BRENTMOOR PARK
SAINT LOUIS MO
63105-3066
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6434
  • Fax:
Mailing address:
  • Phone: 314-289-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2006011974
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025017204
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: