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General NPI Number Information
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NPI Number | 1215278338
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Entity Type | Individual
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Provider Name | KRISTY EATON LPC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 3500 NORTH VILLAGE DR SUIT 216
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City | ST JOSEPH
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State | MO
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Zip | 64506-4979
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Country | US
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Telephone | 660-663-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 28227 177TH STREET
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City | ALTAMONT
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State | MO
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Zip | 64620
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Country | US
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Telephone | 660-663-5791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2013005502
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License Number State | MO
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