Provider Demographics
NPI:1356060057
Name:SMITH, KALEN KRAATZ (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:KALEN
Middle Name:KRAATZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 BOAZ AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3413
Mailing Address - Country:US
Mailing Address - Phone:682-667-6768
Mailing Address - Fax:
Practice Address - Street 1:1927 BOAZ AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-3413
Practice Address - Country:US
Practice Address - Phone:682-667-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018038329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health