Provider Demographics
NPI:1255438883
Name:KIEL, KAROL A (MA)
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:A
Last Name:KIEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KAROL
Other - Middle Name:A
Other - Last Name:KIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA PSYCHOLOGIST
Mailing Address - Street 1:8772 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3730
Mailing Address - Country:US
Mailing Address - Phone:314-962-7788
Mailing Address - Fax:314-962-4158
Practice Address - Street 1:8772 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3730
Practice Address - Country:US
Practice Address - Phone:314-962-7788
Practice Address - Fax:314-962-4158
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO29014OtherBCBS
MO472833OtherMAGELLAN BEHAVIORAL
MO077581OtherVALUE OPTIONS
MO7672416OtherAETNA