Provider Demographics
NPI:1043549041
Name:KENNON-GREGORY, KRISTI (PLPC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KENNON-GREGORY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1418
Mailing Address - Country:US
Mailing Address - Phone:636-528-1996
Mailing Address - Fax:636-528-1833
Practice Address - Street 1:116 S LINCOLN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1418
Practice Address - Country:US
Practice Address - Phone:636-528-1996
Practice Address - Fax:636-528-1833
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional