Healthcare Provider Details

I. General information

NPI: 1225541501
Provider Name (Legal Business Name): KATHLEEN MARIE MCCLAIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE 401
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

2358 WESGLEN ESTATES DR
MARYLAND HEIGHTS MO
63043-4158
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8100
  • Fax: 314-953-8150
Mailing address:
  • Phone: 314-953-8103
  • Fax: 314-953-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004037086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: