Provider Demographics
NPI:1215577382
Name:KERBEL, BROOKE BLYTHE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:BLYTHE
Last Name:KERBEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BLYTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 SIGSBEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3711
Mailing Address - Country:US
Mailing Address - Phone:636-432-3081
Mailing Address - Fax:
Practice Address - Street 1:12810 TESSON FERRY RD STE 103
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2913
Practice Address - Country:US
Practice Address - Phone:314-650-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019047962101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional