Provider Demographics
NPI:1003858382
Name:HERLIEN, KENNETH JAMES (LPC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:HERLIEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 DELMAR BLVD.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:314-517-2124
Mailing Address - Fax:314-983-0331
Practice Address - Street 1:8420 DELMAR BLVD.
Practice Address - Street 2:SUITE 209
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124
Practice Address - Country:US
Practice Address - Phone:314-517-2124
Practice Address - Fax:314-983-0331
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
34375OtherNATL BOARD CERT COUNSELOR