=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831233022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE MARIE ST.JOHN LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 ARMSTRONG AVE
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66101-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-233-3337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 937 SANTA FE ST
-----------------------------------------------------
City | ATCHISON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66002-2334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-426-1225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 249
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------