Provider Demographics
NPI:1376335943
Name:BALLINGER, KIM RYNEE (LPC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:RYNEE
Last Name:BALLINGER
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 1:1129 STONE CRST
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1546
Mailing Address - Country:US
Mailing Address - Phone:573-430-9205
Mailing Address - Fax:
Practice Address - Street 1:1129 STONE CRST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63628-1546
Practice Address - Country:US
Practice Address - Phone:573-430-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional