Provider Demographics
NPI:1043717762
Name:ENGLUND-MORETON, KARI KAY
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:KAY
Last Name:ENGLUND-MORETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 ORCHARD CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1098
Mailing Address - Country:US
Mailing Address - Phone:618-444-5893
Mailing Address - Fax:
Practice Address - Street 1:3109 S GRAND BLVD STE K
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1039
Practice Address - Country:US
Practice Address - Phone:618-515-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018009366101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health