Provider Demographics
NPI:1235385063
Name:DE VRIES, JOSEPH MILTON (PLPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MILTON
Last Name:DE VRIES
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 W LINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1091
Mailing Address - Country:US
Mailing Address - Phone:417-848-8919
Mailing Address - Fax:
Practice Address - Street 1:3944 W LINWOOD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1091
Practice Address - Country:US
Practice Address - Phone:417-848-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008024001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional