Individual
DR. KENNETH C. MACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3040 W WILDFLOWER CT, COLUMBIA, MO 65203-9573
(573) 442-9255
(573) 442-9255
Mailing address
3040 W WILDFLOWER CT, COLUMBIA, MO 65203-9573
(573) 442-9255
(573) 442-9255
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00304
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13738
BLUE CROSS
MO
Enumeration date
07/27/2006
Last updated
07/08/2007
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