Provider Demographics
NPI:1093949406
Name:LABARGE, DENISE MARIE (RN, LPC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:LABARGE
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13222 FAIROYAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1924
Mailing Address - Country:US
Mailing Address - Phone:314-503-5497
Mailing Address - Fax:
Practice Address - Street 1:13610 BARRETT OFFICE DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7816
Practice Address - Country:US
Practice Address - Phone:314-503-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028437101YP2500X
MO080733163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse