Provider Demographics
NPI:1033684923
Name:KRUS-WHITESIDE, GABRIELLE CHRISTINA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:CHRISTINA
Last Name:KRUS-WHITESIDE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:GABRIELLE
Other - Middle Name:CHRISTINA
Other - Last Name:KRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1457 BALI CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1607
Mailing Address - Country:US
Mailing Address - Phone:314-596-7046
Mailing Address - Fax:
Practice Address - Street 1:400 N 5TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1808
Practice Address - Country:US
Practice Address - Phone:636-277-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018002534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional