1902996879 NPI number — CATHERINE DEVANEY LPC

Table of content: CATHERINE DEVANEY LPC (NPI 1902996879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902996879 NPI number — CATHERINE DEVANEY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVANEY
Provider First Name:
CATHERINE
Provider Middle Name:
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:
1902996879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 S SILVER SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE GIRARDEAU
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63703-7536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-334-1100
Provider Business Mailing Address Fax Number:
573-334-8819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 N SPRING ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PERRYVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63775-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-547-8305
Provider Business Practice Location Address Fax Number:
573-547-8306
Provider Enumeration Date:
10/13/2006

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: 101YP2500X , with the licence number:  2001032010 , 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: 495871709 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 256139 . This is a "COMPSYCH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 162923 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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