Healthcare Provider Details

I. General information

NPI: 1134049737
Provider Name (Legal Business Name): JOSIAH ANDREW KIME LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MARIE LN
MANCHESTER MO
63011-3905
US

IV. Provider business mailing address

416 MARIE LN
MANCHESTER MO
63011-3905
US

V. Phone/Fax

Practice location:
  • Phone: 321-352-1739
  • Fax:
Mailing address:
  • Phone: 321-352-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2025027042
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: