| Doctor Name: | MR. KENNETH JAMES HERLIEN |
| NPI Number: | 1003858382 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 001891 |
| Business Practice Address: | 8420 Delmar Blvd. Suite 209 St Louis, MO - 63124 |
| Business Phone Number: | 3145172124 |
| Business Fax Number: | 3149830331 |
| Mailing Address: | 8420 Delmar Blvd., Suite 209 ST LOUIS |
| State: | MO |
| Postal Code: | 63124 |
| Phone Number: | 3145172124 |
| Fax Number: | 3149830331 |
| NPI Enumeration Date: | 06/12/2006 |
| NPI Last Update Date: | 04/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 001891 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |