Provider Demographics
NPI:1598951048
Name:COYLE, KRISTINE EILEEN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:EILEEN
Last Name:COYLE
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 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:660-885-2393
Practice Address - Street 1:301 N 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1137
Practice Address - Country:US
Practice Address - Phone:816-633-5921
Practice Address - Fax:816-633-7942
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional