Provider Demographics
NPI:1225304256
Name:STUCKEY, KIMBERLY LEE (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LEE
Last Name:STUCKEY
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 1:103 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1603
Mailing Address - Country:US
Mailing Address - Phone:636-978-6901
Mailing Address - Fax:
Practice Address - Street 1:103 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1603
Practice Address - Country:US
Practice Address - Phone:636-978-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional