Provider Demographics
NPI:1538408273
Name:MOIST, KAREN R (MA, LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:MOIST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8147 DELMAR BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3735
Mailing Address - Country:US
Mailing Address - Phone:314-399-9576
Mailing Address - Fax:
Practice Address - Street 1:8147 DELMAR BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3735
Practice Address - Country:US
Practice Address - Phone:314-399-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional