Healthcare Provider Details

I. General information

NPI: 1144867300
Provider Name (Legal Business Name): KATHERINE ANN BRUNSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HUBER PARK CT STE 171
WELDON SPRING MO
63304-8666
US

IV. Provider business mailing address

520 HUBER PARK CT STE 171
WELDON SPRING MO
63304-8666
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-9953
  • Fax:
Mailing address:
  • Phone: 636-344-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018030572
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: