Provider Demographics
NPI:1851169734
Name:KRULL, ELAINE MICHELE (MED, PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MICHELE
Last Name:KRULL
Suffix:
Gender:F
Credentials:MED, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2508
Mailing Address - Country:US
Mailing Address - Phone:314-798-7375
Mailing Address - Fax:
Practice Address - Street 1:1804 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2508
Practice Address - Country:US
Practice Address - Phone:314-798-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023015673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health