Provider Demographics
NPI:1194063313
Name:MCCLAIN, KYLE THOMAS (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:THOMAS
Last Name:MCCLAIN
Suffix:
Gender:M
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 1:26 MILLRACE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2711
Mailing Address - Country:US
Mailing Address - Phone:314-610-5547
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 430
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-610-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003032187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional