Provider Demographics
NPI:1457703860
Name:KEBEL, LIZA B (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:B
Last Name:KEBEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SPENCER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2574
Mailing Address - Country:US
Mailing Address - Phone:636-939-2550
Mailing Address - Fax:314-222-0514
Practice Address - Street 1:255 SPENCER RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2574
Practice Address - Country:US
Practice Address - Phone:636-939-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional