Provider Demographics
NPI:1437280088
Name:DOYLE, KEVIN LAWRENCE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LAWRENCE
Last Name:DOYLE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 SUNSET OFFICE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1016
Mailing Address - Country:US
Mailing Address - Phone:314-965-7494
Mailing Address - Fax:314-965-9970
Practice Address - Street 1:10820 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1016
Practice Address - Country:US
Practice Address - Phone:314-965-7494
Practice Address - Fax:314-965-9970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0052421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO113869OtherBCBS OF MO PROV ID