Individual
MS. KELLY DILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, MAC
Contact information
Practice address
13354 MANCHESTER RD STE 210, SAINT LOUIS, MO 63131-1737
(314) 374-5000
Mailing address
1304 BANSBACH RD, SAINT LOUIS, MO 63131-4002
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2011030041
MO
Other
Enumeration date
07/06/2012
Last updated
08/27/2015
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