Provider Demographics
NPI:1700039088
Name:VONBEHREN, KRISTA DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:DAWN
Last Name:VONBEHREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E SOUTH HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2659
Mailing Address - Country:US
Mailing Address - Phone:660-562-2525
Mailing Address - Fax:660-562-4303
Practice Address - Street 1:114 E SOUTH HILLS DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2659
Practice Address - Country:US
Practice Address - Phone:660-562-2525
Practice Address - Fax:660-562-4303
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080134751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008013475OtherMISSOURI LICENSE