Provider Demographics
NPI:1538489034
Name:REDLICH, KIMBERLY D (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:REDLICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S PREWITT ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3834
Mailing Address - Country:US
Mailing Address - Phone:417-844-9976
Mailing Address - Fax:
Practice Address - Street 1:507 S PREWITT ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3834
Practice Address - Country:US
Practice Address - Phone:417-844-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008035710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional