Provider Demographics
NPI:1295279487
Name:THERIOT, KRISTI LYNN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:THERIOT
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 1:752 ESTES PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2089
Mailing Address - Country:US
Mailing Address - Phone:636-734-4063
Mailing Address - Fax:314-739-6325
Practice Address - Street 1:11300 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2721
Practice Address - Country:US
Practice Address - Phone:314-739-6811
Practice Address - Fax:314-739-6825
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010008295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional