Provider Demographics
NPI:1629336177
Name:WHITE, KRISTI RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:RENEE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-1614
Mailing Address - Country:US
Mailing Address - Phone:660-562-3000
Mailing Address - Fax:660-562-3002
Practice Address - Street 1:423 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468
Practice Address - Country:US
Practice Address - Phone:660-562-3000
Practice Address - Fax:660-562-3002
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120036451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1629336177Medicaid