Provider Demographics
NPI:1164760062
Name:ADAMO, DUSTIN BRYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:BRYCE
Last Name:ADAMO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 KEATON CROSSING BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8404
Mailing Address - Country:US
Mailing Address - Phone:636-300-9333
Mailing Address - Fax:636-300-8761
Practice Address - Street 1:4142 KEATON CROSSING BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8404
Practice Address - Country:US
Practice Address - Phone:636-300-9333
Practice Address - Fax:636-300-8761
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002477103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling