Provider Demographics
NPI:1144584632
Name:KIRCHOFF DYSART, KAREN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KIRCHOFF DYSART
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DYSART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2388 SCHUETZ RD
Mailing Address - Street 2:A 50
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3414
Mailing Address - Country:US
Mailing Address - Phone:636-399-8112
Mailing Address - Fax:314-692-8258
Practice Address - Street 1:2388 SCHUETZ RD
Practice Address - Street 2:A 50
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3414
Practice Address - Country:US
Practice Address - Phone:636-399-8112
Practice Address - Fax:314-692-8258
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional