Provider Demographics
NPI:1508065822
Name:KIEL, LARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:KIEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 CRAIGWOODS DR
Mailing Address - Street 2:SUITE S
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5516
Mailing Address - Country:US
Mailing Address - Phone:314-821-4357
Mailing Address - Fax:314-822-9255
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:SUITE S
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-821-4357
Practice Address - Fax:314-822-9255
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY116103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral