=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144518168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KLYNN COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2011
-----------------------------------------------------
Last Update Date | 10/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 CRAIG RD SUITE 260
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63146-5277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-569-9848
-----------------------------------------------------
Fax | 314-569-9851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 CRAIG RD SUITE 206
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63146-5277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-569-9848
-----------------------------------------------------
Fax | 314-569-9851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KAREN LYNN BECKER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 314-569-9848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2010035822
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------