Provider Demographics
NPI:1902632128
Name:BRAUN, KRYSTAL J (MA, PLPC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:J
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:J
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10081 ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:CADET
Mailing Address - State:MO
Mailing Address - Zip Code:63630-8373
Mailing Address - Country:US
Mailing Address - Phone:573-854-3577
Mailing Address - Fax:
Practice Address - Street 1:334 N STATE ST STE A
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3073
Practice Address - Country:US
Practice Address - Phone:573-854-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023028280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health