Provider Demographics
NPI:1265644611
Name:KNUBLEY, STEPHEN LEE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:KNUBLEY
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 GASCONY WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1418
Mailing Address - Country:US
Mailing Address - Phone:314-630-2642
Mailing Address - Fax:314-909-7073
Practice Address - Street 1:12813 FLUSHING MEADOWS DR
Practice Address - Street 2:SUITE 140
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1835
Practice Address - Country:US
Practice Address - Phone:314-630-2642
Practice Address - Fax:314-909-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional