Basic Information
Provider Information
NPI: 1831650084
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARBER
FirstName: KRISTEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4153 PROJECT RD
Address2:  
City: LUEBBERING
State: MO
PostalCode: 630613205
CountryCode: US
TelephoneNumber: 3147505811
FaxNumber:  
Practice Location
Address1: 1780 OLD HIGHWAY 50 E
Address2:  
City: UNION
State: MO
PostalCode: 630843397
CountryCode: US
TelephoneNumber: 6365828100
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/29/2019
LastUpdateDate: 03/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X2013044765MOY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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