Ebberup-Krug, Kellie Adrienne
Ebberup-Krug, Kellie Adrienne is an sole proprietor health care provider with primary practice located at 930 Morgan Drive , Whiteman Afb MO 65305-1180. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Ebberup-Krug, Kellie Adrienne can be contacted via phone (901) 336-2626.Contact Information
Primary practice address
930 Morgan Drive
Whiteman Afb MO 65305-1180
Phone: (901) 336-2626
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 2019038935 | Missouri |
Profile Details
| NPI number | 1275177255 |
|---|---|
| LBN Legal business name | Ebberup-Krug, Kellie Adrienne |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 1st, 2019 |
| Last updated | Dec 6th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275177255 | NPPES |
| Missouri | MEDICAID | 490077188 |
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