Provider Demographics
NPI:1073262143
Name:GINN, DEVORAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEVORAH
Middle Name:
Last Name:GINN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 LIBRA DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-3008
Mailing Address - Country:US
Mailing Address - Phone:314-374-6023
Mailing Address - Fax:
Practice Address - Street 1:1347 LIBRA DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3008
Practice Address - Country:US
Practice Address - Phone:314-374-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013042514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical