| Doctor Name: | CRYSTAL KWENTUS |
| NPI Number: | 1073970695 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, ATR, LPC |
| License Number: | 2011036955 |
| Business Practice Address: | 330 N Gore Ave Webster Groves, MO - 631191600 |
| Business Phone Number: | 3149194773 |
| Business Fax Number: | |
| Mailing Address: | 4123 Shenandoah Ave, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631103930 |
| Phone Number: | 3145915066 |
| Fax Number: | |
| NPI Enumeration Date: | 01/27/2016 |
| NPI Last Update Date: | 01/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2011036955 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |