Provider Demographics
NPI:1518074657
Name:DURBAN, PENELOPE KARLA (LPC)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:KARLA
Last Name:DURBAN
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 1:14323 SOUTH OUTER 40
Mailing Address - Street 2:SUITE 607 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-275-2500
Mailing Address - Fax:314-275-7773
Practice Address - Street 1:14323 SOUTH OUTER 40
Practice Address - Street 2:SUITE 607 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-275-2500
Practice Address - Fax:314-275-7773
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004212729OtherAETNA
212591OtherHEALTHLINK
39171OtherGHP CMR
IP289560OtherMAGELLAN
11257320OtherCAQH
MO113652OtherBLUE CROSS
120767OtherCOMPSYCH
215041OtherPHCS
6269110OtherUBH
021679OtherVMC BEHAVIORAL
007981OtherVENDOR ID
100167OtherMANAGED HEALTH NETWORK
1071212OtherCIGNA
147764OtherVALUE OPTION