Provider Demographics
NPI:1114692357
Name:NEWMAN, KIEL (LPC)
Entity Type:Individual
Prefix:
First Name:KIEL
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 WICKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3004
Mailing Address - Country:US
Mailing Address - Phone:314-413-3103
Mailing Address - Fax:
Practice Address - Street 1:2055 CRAIGSHIRE RD STE 407C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4012
Practice Address - Country:US
Practice Address - Phone:314-413-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019029436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional