1033391388 NPI number — MRS. KATHLEEN MARIE EMMERT LPC

Table of content: MRS. KATHLEEN MARIE EMMERT LPC (NPI 1033391388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033391388 NPI number — MRS. KATHLEEN MARIE EMMERT LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMMERT
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033391388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220081
Provider Second Line Business Mailing Address:
MIDWEST COUNSELING & CONSULTING, LLC
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-504-3828
Provider Business Mailing Address Fax Number:
636-458-6101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 OLIVE ST STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63103-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-206-3700
Provider Business Practice Location Address Fax Number:
314-206-3751
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2008014111 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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