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General NPI Number Information
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NPI Number | 1154675494
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Entity Type | Individual
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Provider Name | KEVIN HERBERT LPC
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Gender | Male
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 1600 HERITAGE LNDG STE 201
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City | SAINT PETERS
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State | MO
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Zip | 63303-8488
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Country | US
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Telephone | 636-219-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 OAKLAND HILLS DR
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City | O FALLON
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State | MO
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Zip | 63366-5569
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Country | US
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Telephone | 636-219-5432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2011024362
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2011024362
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2011024362
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License Number State | MO
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