Healthcare Provider Details

I. General information

NPI: 1437270410
Provider Name (Legal Business Name): RICKY CORDALE KIMES M.A. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 SAINT ROBERT PLAZA DR
SAINT ROBERT MO
65584-3312
US

IV. Provider business mailing address

165 SAINT ROBERT PLAZA DR
SAINT ROBERT MO
65584-3312
US

V. Phone/Fax

Practice location:
  • Phone: 573-528-7760
  • Fax:
Mailing address:
  • Phone: 573-528-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4516
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006246
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2023045478
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: