Healthcare Provider Details

I. General information

NPI: 1144690975
Provider Name (Legal Business Name): KEVIN PLANCHET LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 MACKLIND AVE
SAINT LOUIS MO
63109-3569
US

IV. Provider business mailing address

7116 CLAYTON RD
RICHMOND HEIGHTS MO
63117-1505
US

V. Phone/Fax

Practice location:
  • Phone: 504-912-5561
  • Fax: 504-648-5921
Mailing address:
  • Phone: 504-912-5561
  • Fax: 504-684-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5348
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5348
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: