Provider Demographics
NPI:1033623475
Name:VAIL, DEBORAH (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:VAIL
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FORT ZUMWALT SQ STE 121
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3078
Mailing Address - Country:US
Mailing Address - Phone:636-626-4300
Mailing Address - Fax:719-487-3251
Practice Address - Street 1:300 FORT ZUMWALT SQ STE 121
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3078
Practice Address - Country:US
Practice Address - Phone:636-626-4300
Practice Address - Fax:719-487-3251
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023007976101YP2500X
COLPC.0017424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional