Provider Demographics
NPI:1114225620
Name:LAURIE, DEBRA MADDOX (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MADDOX
Last Name:LAURIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MADDOX
Other - Last Name:KIRCHHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2808
Mailing Address - Country:US
Mailing Address - Phone:573-246-6000
Mailing Address - Fax:
Practice Address - Street 1:500 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2808
Practice Address - Country:US
Practice Address - Phone:573-246-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0040331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical