Active NPI
Christina Antoinette Indriolo, PLPC
- Mental Health Counselor
- Kirkwood, MO
National Provider Identifier
1598414617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2020029081
- Practice address
- 112 W Jefferson Ave Ste 130
Kirkwood, MO 63122-4062 - Phone
- (636) 492-1104
- NPI assigned
- Mar 23, 2022
- Last updated
- Mar 23, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2020029081 | MO | Primary |
Addresses
Primary practice location
112 W Jefferson Ave Ste 130
Kirkwood, MO 63122-4062
Mailing address
6025 Pershing Ave Apt 2
Saint Louis, MO 63112-1322
Phone (636) 492-1104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 21, 2025 through Feb 21, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020029081 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647993600000",
"number": "1598414617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6025 PERSHING AVE APT 2",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631121322",
"telephone_number": "636-492-1104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 W JEFFERSON AVE STE 130",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224062",
"telephone_number": "636-492-1104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDRIOLO",
"first_name": "CHRISTINA",
"middle_name": "ANTOINETTE",
"credential": "PLPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-23",
"last_updated": "2022-03-23",
"certification_date": "2022-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2020029081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.