Healthcare Provider Details

I. General information

NPI: 1568981272
Provider Name (Legal Business Name): CHRISTINA DENISE BRIMM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT STE 203
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

1387 TIMOTHY RIDGE DR
SAINT CHARLES MO
63304-3438
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-1011
  • Fax:
Mailing address:
  • Phone: 314-229-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015035422
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: