Provider Demographics
NPI:1811130214
Name:ENTRUP, KATHY B (MS, LPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:B
Last Name:ENTRUP
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 MANCHESTER RD
Mailing Address - Street 2:SU 190
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4423
Mailing Address - Country:US
Mailing Address - Phone:217-222-8977
Mailing Address - Fax:217-222-8977
Practice Address - Street 1:12015 MANCHESTER RD
Practice Address - Street 2:SU 190
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-4423
Practice Address - Country:US
Practice Address - Phone:217-222-8977
Practice Address - Fax:217-222-8977
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004734101YM0800X
MO2000168606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional