Provider Demographics
NPI:1508591645
Name:WAY, DEBORAH REGINA (MA LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:REGINA
Last Name:WAY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CHAUCER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3619
Mailing Address - Country:US
Mailing Address - Phone:314-973-3369
Mailing Address - Fax:
Practice Address - Street 1:3200 CHAUCER AVE
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3619
Practice Address - Country:US
Practice Address - Phone:314-973-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022021049101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health