Provider Demographics
NPI:1386020071
Name:COMPTON, KIMBERLY DORIS (MA, LPC, NCC, MAC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DORIS
Last Name:COMPTON
Suffix:
Gender:F
Credentials:MA, LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 TRIO LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-3450
Mailing Address - Country:US
Mailing Address - Phone:314-322-7749
Mailing Address - Fax:314-371-6500
Practice Address - Street 1:10225 TRIO LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137
Practice Address - Country:US
Practice Address - Phone:314-322-7749
Practice Address - Fax:314-371-6500
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026842101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490036302Medicaid