Provider Demographics
NPI:1255301420
Name:KEMP, LOU THELEN (MA)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:THELEN
Last Name:KEMP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2052
Mailing Address - Country:US
Mailing Address - Phone:417-326-2902
Mailing Address - Fax:417-326-4555
Practice Address - Street 1:315 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2052
Practice Address - Country:US
Practice Address - Phone:417-326-2902
Practice Address - Fax:417-326-4555
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO170159OtherBLUE CROSS BLUE SHIELD