Provider Demographics
NPI:1760001457
Name:MCGUINESS, KIMBERLEY
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:MCGUINESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13037 WHEATFIELD FARM RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8546
Mailing Address - Country:US
Mailing Address - Phone:314-283-7617
Mailing Address - Fax:
Practice Address - Street 1:249 LAMP AND LANTERN VILLAGE
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:36017
Practice Address - Country:US
Practice Address - Phone:314-283-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019003417390200000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONAOtherPRIVATE PAY PRACTICE