=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902632128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTAL J. BRAUN M.A, PLPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 09/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 334 N STATE ST STE A
-----------------------------------------------------
City | DESLOGE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63601-3073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-854-3577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10081 ROLLING HILLS RD
-----------------------------------------------------
City | CADET
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63630-8373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-854-3577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2023028280
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------