Provider Demographics
NPI:1245759414
Name:SCALLORN, DEBORAH S (MA, LPC, CRC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:SCALLORN
Suffix:
Gender:F
Credentials:MA, LPC, CRC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:S
Other - Last Name:HARDESTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, CRC
Mailing Address - Street 1:2352 GROSS POINT LN
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 OLD BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7051
Practice Address - Country:US
Practice Address - Phone:314-569-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015039993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional