Provider Demographics
NPI:1396404323
Name:REVELLE, KATE (LPC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:REVELLE
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 1:804 WINDINGPATH LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6636
Mailing Address - Country:US
Mailing Address - Phone:636-667-9691
Mailing Address - Fax:
Practice Address - Street 1:804 WINDINGPATH LN
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-6636
Practice Address - Country:US
Practice Address - Phone:636-667-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional