Provider Demographics
NPI:1104257385
Name:THORNTON, KAREN MISTY (LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MISTY
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1410
Mailing Address - Country:US
Mailing Address - Phone:816-508-1700
Mailing Address - Fax:816-508-1757
Practice Address - Street 1:1750 S BRENTWOOD BLVD STE 503
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:314-881-0350
Practice Address - Fax:816-508-1757
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MO2016019476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator