Provider Demographics
NPI:1528198553
Name:KINSELLA, ALICE K (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:K
Last Name:KINSELLA
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 1:533 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1860
Mailing Address - Country:US
Mailing Address - Phone:314-412-3375
Mailing Address - Fax:
Practice Address - Street 1:533 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-1860
Practice Address - Country:US
Practice Address - Phone:314-339-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495303208Medicaid
MO1528198553Medicaid