Provider Demographics
NPI:1023342086
Name:BRUTON REINHOLD, CAMILLE (LPC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:BRUTON REINHOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 OLD BIG BEND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6844
Mailing Address - Country:US
Mailing Address - Phone:314-717-0190
Mailing Address - Fax:314-754-7275
Practice Address - Street 1:12166 OLD BIG BEND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6844
Practice Address - Country:US
Practice Address - Phone:314-717-0190
Practice Address - Fax:314-754-7275
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009029405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009029405OtherMISSOURI PROFESSIONAL COUNSELORS