Basic Information
| Provider Information | |||||||||
| NPI: | 1760711600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 SOUTH KIRKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | KIRKWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142395008 | ||||||||
| FaxNumber: | 3142395008 | ||||||||
| Practice Location | |||||||||
| Address1: | 2949 S BRENTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631442713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149616017 | ||||||||
| FaxNumber: | 3149616436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 04/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2000172496 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.