Healthcare Provider Details

I. General information

NPI: 1821920455
Provider Name (Legal Business Name): LYDIA KIMBROUGH BAER PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT STE 103
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

500 HUBER PARK CT STE 103
WELDON SPRING MO
63304-8683
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-0580
  • Fax:
Mailing address:
  • Phone: 636-344-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026006143
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: