Healthcare Provider Details

I. General information

NPI: 1336772912
Provider Name (Legal Business Name): KINTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHESTERFIELD BUSINESS PKWY STE 200
CHESTERFIELD MO
63005-1271
US

IV. Provider business mailing address

500 N MAIN ST STE 620
ROSWELL NM
88201-4767
US

V. Phone/Fax

Practice location:
  • Phone: 636-825-2200
  • Fax: 636-825-2201
Mailing address:
  • Phone: 808-909-2003
  • Fax: 808-909-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TEIDE BRISIBE EHIMARE
Title or Position: OWNER
Credential: MD
Phone: 573-639-0057