Provider Demographics
NPI:1144690975
Name:PLANCHET, KEVIN (LPC-S)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:PLANCHET
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1505
Mailing Address - Country:US
Mailing Address - Phone:504-912-5561
Mailing Address - Fax:504-684-5921
Practice Address - Street 1:5850 MACKLIND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3569
Practice Address - Country:US
Practice Address - Phone:504-912-5561
Practice Address - Fax:504-648-5921
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5348101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433322Medicaid