Provider Demographics
NPI:1295854396
Name:BOSSE, DEANNA (LPC)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:BOSSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FEE FEE RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3801
Mailing Address - Country:US
Mailing Address - Phone:314-275-7600
Mailing Address - Fax:314-275-8486
Practice Address - Street 1:909 FEE FEE RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3801
Practice Address - Country:US
Practice Address - Phone:314-275-7600
Practice Address - Fax:314-275-8486
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional