1518074657 NPI number — PENELOPE KARLA DURBAN LPC

Table of content: PENELOPE KARLA DURBAN LPC (NPI 1518074657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518074657 NPI number — PENELOPE KARLA DURBAN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURBAN
Provider First Name:
PENELOPE
Provider Middle Name:
KARLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518074657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14323 SOUTH OUTER 40
Provider Second Line Business Mailing Address:
SUITE 607 SOUTH
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-275-2500
Provider Business Mailing Address Fax Number:
314-275-7773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14323 SOUTH OUTER 40
Provider Second Line Business Practice Location Address:
SUITE 607 SOUTH
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-275-2500
Provider Business Practice Location Address Fax Number:
314-275-7773
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  CS000045 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004212729 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212591 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39171 . This is a "GHP CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: IP289560 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11257320 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113652 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 120767 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 215041 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6269110 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021679 . This is a "VMC BEHAVIORAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007981 . This is a "VENDOR ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100167 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1071212 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 147764 . This is a "VALUE OPTION" identifier . This identifiers is of the category "OTHER".




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