Provider Demographics
NPI:1114343613
Name:MALAT, KRISTIN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MALAT
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 WATER WOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4826
Mailing Address - Country:US
Mailing Address - Phone:314-651-6039
Mailing Address - Fax:
Practice Address - Street 1:1506 WATER WOOD LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4826
Practice Address - Country:US
Practice Address - Phone:314-651-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014006570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist