Provider Demographics
NPI:1578126801
Name:TAYLOR-REICHERT, KATHRYN ALLISON (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALLISON
Last Name:TAYLOR-REICHERT
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 CECELIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2514
Mailing Address - Country:US
Mailing Address - Phone:314-560-1573
Mailing Address - Fax:
Practice Address - Street 1:2521 CECELIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2514
Practice Address - Country:US
Practice Address - Phone:314-560-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040353101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016040353OtherSTATE OF MISSOURI, LICENSED PROFESSIONAL COUNSELOR