Provider Demographics
NPI:1043699945
Name:MCCAIN, KENNETH J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 LINDELL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2735
Mailing Address - Country:US
Mailing Address - Phone:314-956-0547
Mailing Address - Fax:
Practice Address - Street 1:4390 LINDELL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2735
Practice Address - Country:US
Practice Address - Phone:314-956-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012184101YP2500X
IL178003806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional