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General NPI Number Information
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NPI Number | 1629109822
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Entity Type | Individual
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Provider Name | BRADLEY MICHAEL KINNEAR LPC
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1 BROOKINGS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4862
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Country | US
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Telephone | 314-935-6666
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Fax | 314-696-1214
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Provider Business Mailing Address
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Address Line | PO BOX 7412043
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City | CHICAGO
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State | IL
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Zip | 60674-2043
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Country | US
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Telephone | 314-935-6666
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Fax | 314-696-1214
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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 | 2007012820
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License Number State | MO
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