Provider Demographics
NPI:1386717007
Name:KALLMAN, KATHLEEN MARIE (LPC, BCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:KALLMAN
Suffix:
Gender:F
Credentials:LPC, BCPC
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:KALLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, BCPC
Mailing Address - Street 1:591 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4733
Mailing Address - Country:US
Mailing Address - Phone:573-433-0315
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY RD 3610
Practice Address - Street 2:
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-0156
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005009300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497293605Medicaid