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General NPI Number Information
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NPI Number | 1215577382
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Entity Type | Individual
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Provider Name | BROOKE BLYTHE KERBEL MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 12810 TESSON FERRY RD STE 103
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2913
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Country | US
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Telephone | 314-650-9537
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Fax |
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Provider Business Mailing Address
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Address Line | 144 SIGSBEE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3711
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Country | US
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Telephone | 636-432-3081
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2019047962
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2019047962
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License Number State | MO
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