Provider Demographics
NPI:1952446981
Name:CHRISMER-STILL, ANDREA D (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:D
Last Name:CHRISMER-STILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10420 OLD OLIVE STREET RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5914
Mailing Address - Country:US
Mailing Address - Phone:314-567-9321
Mailing Address - Fax:314-576-7355
Practice Address - Street 1:2913 MALLARD DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1285
Practice Address - Country:US
Practice Address - Phone:636-724-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11457309OtherCAQH
MO188949OtherBLUECROSSBLUESHIELD