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General NPI Number Information
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NPI Number | 1568779189
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Entity Type | Individual
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Provider Name | MICHAEL MARTIN LUTHER KROWNAPPLE PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 1010 W COLUMBIA ST
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City | FARMINGTON
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State | MO
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Zip | 63640-2902
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Country | US
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Telephone | 573-218-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 2109A RUSSELL BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2606
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Country | US
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Telephone | 314-566-3391
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Fax | 573-218-7053
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2008031123
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License Number State | MO
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