Provider Demographics
NPI:1629227723
Name:KARAVOUSANOS, KELLY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:KARAVOUSANOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 SADDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-2417
Mailing Address - Country:US
Mailing Address - Phone:636-448-4189
Mailing Address - Fax:
Practice Address - Street 1:3 HUNTING CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-4211
Practice Address - Country:US
Practice Address - Phone:636-578-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032313101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor