Provider Demographics
NPI:1407427487
Name:DEPROW, TESS MARIE
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:MARIE
Last Name:DEPROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11861 WESTLINE INDUSTRIAL DR STE 850
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3300
Mailing Address - Country:US
Mailing Address - Phone:314-434-9441
Mailing Address - Fax:314-469-5490
Practice Address - Street 1:11861 WESTLINE INDUSTRIAL DR STE 850
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3300
Practice Address - Country:US
Practice Address - Phone:314-434-9441
Practice Address - Fax:314-469-5490
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017009222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional