Healthcare Provider Details

I. General information

NPI: 1013230853
Provider Name (Legal Business Name): JASON H KIRKPATRICK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY SUITE 300
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

4801 WELDON SPRING PKWY SUITE 300
WELDON SPRING MO
63304-9101
US

V. Phone/Fax

Practice location:
  • Phone: 636-474-9164
  • Fax: 636-949-0729
Mailing address:
  • Phone: 636-474-9164
  • Fax: 636-949-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006013032
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: