Provider Demographics
NPI:1861731259
Name:KIBOU COUNSELING SERVICES INTERNATIONAL LLC
Entity type:Organization
Organization Name:KIBOU COUNSELING SERVICES INTERNATIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMYRUTH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:314-520-8167
Mailing Address - Street 1:4921 MURDOCH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2944
Mailing Address - Country:US
Mailing Address - Phone:314-520-8167
Mailing Address - Fax:
Practice Address - Street 1:201 S SKINKER BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2317
Practice Address - Country:US
Practice Address - Phone:314-520-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008031874251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health