Healthcare Provider Details

I. General information

NPI: 1598951048
Provider Name (Legal Business Name): KRISTINE EILEEN COYLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 2ND ST STE C
ODESSA MO
64076-1137
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-5921
  • Fax: 816-633-7942
Mailing address:
  • Phone: 660-885-8131
  • Fax: 660-885-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007027909
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: