Provider Demographics
NPI:1427527936
Name:KREITLER, MICHAEL A (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:KREITLER
Suffix:
Gender:M
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 1:5640B TELEGRAPH RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4243
Mailing Address - Country:US
Mailing Address - Phone:314-401-3931
Mailing Address - Fax:
Practice Address - Street 1:5640B TELEGRAPH RD STE 260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4243
Practice Address - Country:US
Practice Address - Phone:314-401-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002415101YP2500X
MO103TS0200X
MO2018033466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool