Provider Demographics
NPI:1336519743
Name:LAMANTIA, KIRSTEN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:LAMANTIA
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 S SPRING ST
Mailing Address - Street 2:APT G
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-8421
Mailing Address - Country:US
Mailing Address - Phone:708-557-0971
Mailing Address - Fax:
Practice Address - Street 1:654 S SPRING ST
Practice Address - Street 2:APT G
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-8421
Practice Address - Country:US
Practice Address - Phone:708-557-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health